Understanding dry mouth causes, symptoms, and solutions

When we don't produce enough saliva, the mouth gets dry and uncomfortable. Dry mouth or xerostomia is common in older people affecting around one in five elderly people. Saliva moistens and cleanses the mouth, helps to process food and prevents infection by controlling bacteria and fungi in the mouth. Some people mistake thirst for dry mouth, but the causes are different.

Dry mouth can cause discomfort, affect speech and swallowing, affect dentures, cause bad breath, increase bacteria in the mouth and cause tooth decay in the long term.

What causes dry mouth?

There are several causes of dry mouth:
·   Side effects of certain medications. Dry mouth is a common side effect of some prescription and non-prescription drugs.
·   Side effects of certain medical conditions, for example Sjögren's syndrome, and infections.
·   Side effect of certain medical treatments. Damage to the salivary glands, the glands that produce saliva, for example, from radiation to the head and neck and chemotherapy treatments for cancer, can reduce the amount of saliva produced.
·   Nerve damage. Dry mouth can be a result of nerve damage to the head and neck area from an injury or surgery.
·   Dehydration. Conditions that lead to dehydration, such as fever, excessive sweating, vomiting, diarrhoea, blood loss and burns can cause dry mouth.
·   Surgical removal of the salivary glands.
·   Lifestyle. Smoking or chewing tobacco can affect saliva production and aggravate dry mouth. Continuously breathing with your mouth open can also contribute to the problem.

What are the symptoms of dry mouth?
Common symptoms of dry mouth include:
·  A sticky, dry feeling in the mouth
·  Frequent thirst
·  Sores in the mouth; sores or split skin at the corners of the mouth; cracked lips
·  A dry feeling in the throat
·  A burning or tingling sensation in the mouth and especially on the tongue
·  A dry, red, raw tongue
·  Problems speaking or difficulty tasting, chewing, and swallowing
·  Hoarseness, dry nasal passages, sore throat
·  Bad breath

Why is dry mouth a problem?

Besides causing the aggravating symptoms mentioned above, dry mouth also increases a person's risk of gingivitis ( gum disease), tooth decay and mouth infections, such as thrush. Dry mouth can also make it difficult to wear dentures.

How is dry mouth treated?

If you think your dry mouth is caused by certain medication you are taking, talk to your doctor. He or she may adjust the dose you are taking or change you to a different drug that doesn't cause dry mouth.

In addition, an oral rinse to restore mouth moisture may be prescribed. If that doesn't help a medicine that stimulates saliva production, called pilocarpine hydrochloride may be prescribed.

Other steps you can take that may help improve saliva flow include:
·  Sucking on sugar-free sweets or chewing sugar-free gum
·  Drinking plenty of water to help keep your mouth moist
·  Protecting your teeth by brushing with a fluoride toothpaste, using a fluoride rinse, and visiting your dentist regularly
·  Breathing through your nose, not your mouth, as much as possible
·  Using a room humidifier to add moisture to the bedroom air
·  Using an over-the-counter artificial saliva substitute

Medical treatment for dry mouth

Treatment for dry mouth depends on what is causing the problem. Generally, treatment of a dry mouth focuses on three areas:
·  Managing underlying medical conditions causing the dry mouth
·  Preventing tooth decay
·  Increasing the flow of saliva, if possible.

Managing underlying causes of dry mouth

If dry mouth is caused by a health-related situation that can be changed, your dentist or doctor will consider making a change. For example, if your dry mouth is caused by a medication - dry mouth is a common side effect of some drugs - your dentist or doctor may change your medication or adjust the dosage.

Other possible causes that can be addressed include mouth breathing (usually due to a blocked nose) and anxiety.

Preventing tooth decay due to dry mouth

Not only does saliva help digest food and make it possible for you to chew and swallow, it is the natural mouth cleanser. Without saliva, tooth decay and gum disease are more likely to occur. If you have a dry mouth, to combat tooth decay and gum disease, you need to be extra careful about following good oral hygiene habits, which consist of:

·  Brushing your teeth at least twice a day, but preferably, after every meal and before bedtime
·  Flossing your teeth or using interdental brushes every day
·  Using a toothpaste that contains fluoride
·  Visiting your dentist for a check-up and cleaning as advised. During your visit, your dentist may recommend daily use of a fluoride rinse or fluoride gel to keep your teeth healthy.

Increasing the flow of saliva with dry mouth

If you have a dry mouth, your dentist or doctor may initially suggest simple measures such as frequent sips of water, sucking ice-cubes or using sugar-free chewing gum. If these are unsuccessful, you may be prescribed an artificial saliva product in the form of a spray or rinse. These products are also available over-the-counter. Toothpastes, mouthwashes and moisturising gels that are specially formulated for individuals with dry mouth are also available, but usually not on prescription.

You may also be prescribed a medication to increases the natural production of saliva, such as pilocarpine. This often helps when the cause of the dry mouth is a side-effect of medication, and in people who have had radiotherapy.

Finally, there are promising new treatments under investigation. Scientists are working on ways to repair salivary glands that have been damaged and are developing an artificial salivary gland that can be implanted into the body.

What can I do to manage dry mouth?

To minimize dry mouth:
·  Drink water frequently to keep your mouth moist and loosen mucus. Carry water with you to sip throughout the day and keep water by your bed at night.
·  Suck on sugar-free hard sweets, ice chips, or sugar-free ice lollipops. Chew sugarless gum. These sucking and chewing actions help stimulate saliva flow.
·  Moisten foods with broths, soups, sauces, gravy, creams and butter or margarine. Eat soft, moist foods that are cool or at room temperature.
·  Avoid commercial mouth rinses or mouthwashes that contain alcohol or peroxide. These ingredients will further dry out your mouth.
·  Reduce or avoid salty foods, dry foods (for example, cream crackers, toast, biscuits, dry breads, dry meats/poultry/fish, dried fruit, bananas) and foods and beverages with a high sugar content.
·  Reduce or avoid drinks containing alcohol or caffeine (for example, coffees, teas, some colas, chocolate-containing drinks). Alcohol increases water loss by triggering frequent urination. Alcohol, as well as caffeine, also dries out the mouth. Also avoid acidic beverages, such as any fruit juices (orange, apple, grape, grapefruit) and tomato juice.

Other tips to reduce irritation associated with dry mouth include:
·  Minimise your intake of spicy or salty foods as these may cause pain in a dry mouth.
·  Stop smoking.
·  Use a moisturiser on your lips to minimise irritation and cracking.
·  Use a soft-bristled toothbrush on your teeth and gums; rinse your mouth before and after meals with plain water or a mild mouth rinse. Brush with a fluoride-containing toothpaste.
·  Use a humidifier to increase the humidity in your home, especially at night.