Dry mouth, or xerostomiaoccurs when there is not enough saliva (or “saliva”) to lubricate the tongue, gums, and inside of the cheeks. Saliva is essential for chewing, swallowing, digestion, protection against infection and keeping teeth clean.
Dry mouth is often a temporary response to stress or nervousness. Chronic dry mouth can be a sign of side effects from medications, certain medical conditions (such as Sjogren’s syndrome), nerve damage, and radiation therapy.
Treatments focus on restoring hydration in the mouth and preventing relapse. Addressing the underlying cause of dry mouth should lead to a full recovery.
In addition to changes in habits and lifestyle, prescription and over-the-counter (OTC) medications can play a central role in managing dry mouth. They do this by promoting saliva production or serving as a synthetic substitute. Here are some of the medications that can be used:
Prescription
Oral or topical medications can stimulate saliva production. Known as sialogoguesthis includes:
- Salagen (pilocarpine hydrochloride): Salagen stimulates acetylcholine, a neurotransmitter that promotes saliva production. The US Food and Drug Administration (FDA) has approved it for those undergoing radiation treatment or who have Sjogren’s syndrome.
- Evokac (cevimeline): Evokac tablets stimulate saliva production and are FDA approved for those with Sjogren’s syndrome. Common side effects include sweating, nausea, rhinitis (inflammation of the nasal passages), diarrhea, and increased urination.
- Numoisin (sorbitol): Sorbitol is a lozenge that stimulates taste pathways in the tongue and mouth. It is used as needed to manage dry mouth and the symptoms of treatments such as radiation therapy. Rare adverse events include allergic reactions (rash, hives, swelling, wheezing and skin symptoms), mouth irritation and taste changes.
- Topical physostigmine: Physostigmine is a topical gel that is applied directly into the mouth. It is usually used to treat glaucoma (an eye disease), but it can also be used to treat dry mouth.
over the counter (OTC)
Sprays, lozenges, and other aids that stimulate saliva can help manage dry mouth. These include the following medicines:
- Malic acid: Malic acid helps manage dry mouth and increases saliva production. It is available as a mouthwash (Xerodent) or a mouth spray (Dentaid).
- XyliMelt: XyliMelt discs dissolve in the mouth, gradually stimulating saliva and providing long-lasting protection against dry mouth. In one study, three weeks of regular use significantly improved symptoms and increased saliva production.
- Tablets or sprays: Specialized lozenges or sprays, such as Salese or Biotene, are available over the counter and work like prescription Numoisin. Ingredients like sorbitol help prevent tooth decay, which can be a side effect of some other products.
- Saliva Substitutes: OTC saliva substitutes, which come in gels or sprays, are taken as needed. Instead of stimulating saliva, they mimic it. These include Xerostom, Bucalsone and other products containing cellulose gum and minerals such as phosphate, calcium and fluoride.
In persistent and severe cases, health professionals consider surgery to repair the salivary glands, where saliva is produced. Sialendoscopy emerged as a minimally invasive alternative to open surgery.
Surgeons use an endoscope, a small flexible tube with a light and camera, to examine the salivary glands in the mouth. They then make small cuts or changes in the tissue to stimulate the flow of saliva. With this minimally invasive procedure, complications are rare.
Lifestyle changes are generally considered before medication or other methods. They can treat the causes of dry mouth and prevent it from occurring. Strategies that can help include:
- Change medications: Blood pressure medications, certain antidepressants, anticholinergic medications, diuretics, and antiepileptics (or anti-seizure medications) are among the many medications that can cause dry mouth.
- drink water: Sipping water regularly can help keep your mouth lubricated. Adults should drink 9-12 glasses of water a day.
- Avoid caffeine: Caffeine in coffee, tea, and some sodas can also cause dry mouth. Limiting these beverages can help prevent dry mouth and dehydration.
- Avoid or quit smoking: Along with other health effects, smoking tobacco can also lead to dry mouth. Avoiding this habit can help manage this condition.
- Chew flavorless gum: Chewing sugar-free, unflavored gum or sucking on sugar-free hard candies can help your body make more saliva.
- Limit or stop alcohol: Alcohol can also dry out the inside of the mouth. Limiting or stopping drinking altogether can help you manage xerostomia.
- Use a moisturizer: Dry air in the home, especially at night, can increase the risk of dry mouth. Try using a humidifier while you sleep to prevent this problem.
Although dry mouth is not fatal, it can significantly affect your quality of life and cause several health problems. If left untreated, possible complications include:
- Poor nutrition, as a result of poor digestion
- Gingivitis and periodontitiswhat are gum diseases
- Caries and erosion of tooth enamel
- Halitosis, or chronic bad breath
- A yeast infection of the mouth, known as candidiasis
Dry mouth can be managed and even cured, depending on the underlying cause. If smoking, alcohol, or medications are causing your dry mouth, addressing these causes can cure them.
Dry mouth is more persistent and more difficult to treat when associated with radiation therapy, Sjogren’s syndrome, or chronic disease. Current therapies can help relieve symptoms.
If you have chronic dry mouth, it is important to know how to reduce the symptoms. Because saliva is so important to oral health, maintaining your teeth is key. This means brushing your teeth at least twice a day, flossing every day, and visiting the dentist for an annual cleaning and checkup.
In addition to any prescribed medications or OTC methods, living with this problem often means talking to your dentist or healthcare provider, adopting lifestyle changes, and taking steps to prevent complications.