Dry Mouth

Xerostomia

Dry mouth, also called xerostomia, occurs when your salivary glands don’t produce enough saliva to keep your mouth wet. While everyone experiences occasional dry mouth when nervous or stressed, persistent dryness can make chewing, swallowing, and speaking difficult, and significantly increases your risk of tooth decay and oral infections.

Table of contents

• What is dry mouth and why saliva matters
• What causes dry mouth
• Signs and symptoms
• How dry mouth is diagnosed
• Treatment options
• Self-care tips for managing dry mouth
• Possible complications

What is dry mouth and why saliva matters

Dry mouth, medically known as xerostomia (pronounced “zeer-oh-STOE-me-uh”), is the condition of not having enough saliva to keep your mouth wet^[1]. Saliva, or spit, is made by salivary glands located around your mouth and throat, including three pairs of major glands called the parotid, submandibular, and sublingual glands, plus hundreds of minor salivary glands^[5].

In healthy people, the daily production of saliva normally ranges from 0.5 to 1.5 liters^[15]. Saliva is about 99% water and less than 1% solids, including electrolytes like sodium and potassium, and organic components like proteins and enzymes^[15]. This fluid plays many important roles that go far beyond simply keeping your mouth moist.

Saliva moistens and breaks down food, making it easier to chew and swallow. It washes away food particles from your teeth and gums, which helps fight tooth decay. The minerals in saliva, such as calcium and phosphate, help keep teeth strong and repair early damage from decay^[5]. Saliva also contains antibodies that fight infections in your mouth and throat^[6]. It helps you taste food properly, makes it possible to speak clearly, and protects the lining of your mouth from physical and chemical injury^[3].

Dry mouth is quite common, affecting about 1 in 5 people overall^[2]. Estimates of how many people experience dry mouth vary widely, with studies reporting anywhere from 1% to 65% depending on the populations studied^[3]. Your risk for dry mouth increases with age, though it’s important to understand that dry mouth is not a normal part of aging^[5]. The higher rates in older adults typically result from taking multiple medications and developing various medical conditions over time.

What causes dry mouth

Dry mouth happens when something causes your salivary glands to produce less saliva. There are many possible reasons for this, ranging from temporary situations to ongoing health conditions^[5].

The most common cause of dry mouth is the side effects of medications. Hundreds of prescription and over-the-counter medicines can cause your salivary glands to make less saliva^[5]. If you check the information that comes with your medication, you may see “dry mouth” listed as a side effect^[2]. Medicines particularly likely to cause dry mouth include those used to treat depression, anxiety, high blood pressure, allergies and colds (antihistamines and decongestants), bladder control problems, and Parkinson’s disease^[2]. Some pain medicines, muscle relaxants, and sedatives can also dry out your mouth^[9].

Certain medical conditions can lead to dry mouth. Sjögren’s syndrome (also spelled Sjögren’s disease or Sjogren’s) is an autoimmune disease that particularly affects the moisture-producing glands and is a major cause of dry mouth^[5]. Other health problems that can cause dry mouth include diabetes, HIV/AIDS, Alzheimer’s disease, stroke, and high blood pressure^[2].

Cancer treatments can damage the salivary glands. If the salivary glands are exposed to radiation during treatment for head and neck cancer, they can be seriously damaged^[5]. Drugs used for chemotherapy and immunotherapy can make saliva thicker, causing the mouth to feel dry^[5]. Virtually all patients receiving radiation therapy for head and neck cancer develop dry mouth^[15].

Other causes include nerve damage from injury or surgery to the head or neck, which can damage the nerves that tell salivary glands to make saliva^[5]. Dehydration from fever, excessive sweating, vomiting, diarrhea, or not drinking enough water can lead to temporary dry mouth^[9]. Lifestyle factors such as smoking or chewing tobacco can lower saliva flow and worsen dry mouth symptoms^[4]. Breathing through your mouth, especially at night, can also contribute to the problem^[9].

Signs and symptoms

The main symptom of dry mouth is a feeling of stickiness or dryness in your mouth. When you speak, it might feel like your tongue sticks to the roof of your mouth^[2]. Saliva may feel thick and stringy rather than thin and watery^[1].

People with dry mouth often experience bad breath. You may have a constant sore throat, or your throat may feel dry. Your voice might become hoarse^[1]. You may feel increased thirst and need to sip water frequently^[4].

Dry mouth can make everyday activities difficult. You may have trouble chewing, swallowing, tasting, or speaking. Swallowing food becomes especially challenging with dry foods like crackers or biscuits^[7]. Some people describe a burning or itchy feeling in the mouth or throat^[5].

Looking in the mirror, you might notice cracked lips or a dry, rough, or red tongue. Your tongue may appear deeply cracked or fissured^[5]. The tongue may tend to stick against the roof of the mouth, or your lips and cheeks may stick against your gums^[7].

You may develop mouth sores or notice that lipstick sticks to your teeth^[1]. If you wear dentures, you may have trouble keeping them in place, since saliva helps create suction between the gum tissues and the denture base^[7].

Your dentist or dental hygienist can often detect dry mouth before you become fully aware of it. They are trained to look for signs such as insufficient pooling of saliva under or around the tongue, cavities affecting the necks of teeth near the gumline or the chewing edges of teeth, and a red, parched, or cracked tongue^[3].

How dry mouth is diagnosed

To determine the cause of your dry mouth, your doctor or dentist will carefully review your medical history and ask about all the medicines you take, including those available without a prescription^[5]. They will examine your mouth to look for signs of dryness.

During an examination, your healthcare provider will check whether your tongue and inner cheeks look dry and textured rather than smooth, shiny, and moist. To measure how much saliva you produce, they may dab around your salivary glands with a piece of gauze^[2]. They will also look for signs of cavities and gum disease, which can both occur as a result of dry mouth^[2].

In some cases, your healthcare provider may suggest blood tests or a test that measures how much saliva you produce^[5]. If your provider suspects that Sjögren’s syndrome is causing your dry mouth, a small sample of cells may be taken from salivary glands in your lip for testing. This procedure is called a biopsy^[14].

Treatment options

Treatment for dry mouth depends on what’s causing it. Your healthcare professional will work to address the underlying problem while also helping you manage symptoms^[1].

If a medicine is causing your dry mouth, your healthcare provider may change your dose or switch you to another medicine that doesn’t cause dry mouth^[14]. It’s important never to stop taking or change the dose of any prescribed medicine without first talking to your doctor.

Your provider may recommend products to moisturize your mouth. These can include prescription medicines, mouth rinses available without a prescription, artificial saliva, or moisturizers to lubricate your mouth^[14]. Saliva substitutes are available commercially and come in various forms including solutions, sprays, gels, and lozenges^[13]. These products typically contain agents to increase thickness, minerals, preservatives, and flavoring. You may need to try different products to find what works best for you^[13].

For people with severe dry mouth due to Sjögren’s syndrome or radiation treatment for head and neck cancer, prescription medications may help stimulate saliva production. Two medicines are available: pilocarpine (brand name Salagen) and cevimeline (brand name Evoxac)^[14]. These drugs should not be used if you have asthma, glaucoma, or heart rhythm problems. The most common side effect is excessive sweating^[13]. It’s best to start with a low dose at bedtime and gradually increase the amount over a few weeks. It can take up to 2 months for these medications to have full effect^[13].

Self-care tips for managing dry mouth

There are many things you can do on your own to help relieve dry mouth symptoms and protect your oral health^[10].

Chew sugar-free gum or suck on sugar-free hard candies to help stimulate saliva flow. Products containing xylitol are particularly good choices, as xylitol can help reduce the risk of dental decay^[10]. However, if xylitol causes you diarrhea or cramps, choose products without it.

Sip water regularly throughout the day to stay hydrated^[10]. Keep a water bottle with you and take small sips often. You might also keep a glass of water by your bed at night. However, understand that water alone doesn’t lubricate the mouth the way saliva does^[20].

Limit your caffeine intake, as caffeine can make your mouth drier. Avoid drinks like coffee, tea, and some sodas^[13]. Do not use mouthwashes that contain alcohol, because they can dry your mouth further^[10]. Stop all tobacco use if you smoke or chew tobacco^[10].

Be aware that spicy or salty foods may cause pain in a dry mouth, so you may want to avoid them^[13]. When eating, sip water or a sugarless drink during meals to make chewing and swallowing easier and improve the taste of food^[1].

Use a humidifier at night to add moisture to the air in your bedroom^[13]. This can help prevent your mouth and throat from drying out while you sleep.

For dry, cracked lips, apply products like Vaseline, Aquaphor, vitamin E oil, or coconut oil frequently during the day^[13]. Do not lick your lips, as this can make dryness worse^[13].

You can also try massaging your salivary glands. To massage the parotid glands, place your fingers on your cheeks and gently push forward. For sublingual gland massage, push your tongue down onto the two soft structures on the floor of your mouth^[20].

Some people find that drinking green tea may help. Green tea contains substances that may protect glandular cells and help increase saliva flow and decrease saliva thickness^[20].

Since dry mouth raises your risk for tooth decay, it’s extremely important to maintain good oral hygiene. Brush your teeth at least twice a day with fluoride toothpaste and floss daily^[6]. Use a mouthwash designed for dry mouth, especially ones containing xylitol if you tolerate it^[10]. See your dentist at least twice a year^[6].

Possible complications

When you have chronic dry mouth, you’re more likely to develop several oral health problems^[2]. Without adequate saliva to wash away bacteria and neutralize acids, tooth decay becomes much more common. People with dry mouth have an increased risk of cavities, especially cavities that form at the gum line or on chewing surfaces^[3].

Dry mouth also increases your chances of developing gum disease and mouth sores^[2]. You may experience cracked lips that don’t heal easily. Fungal infections in the mouth, such as oral thrush, become more likely because saliva normally helps keep harmful germs in check^[5].

Reduced salivary flow can interfere with chewing or swallowing certain foods, which in severe cases may lead to poor nutrition^[15]. The severity of dry mouth symptoms can range from mild oral discomfort to significant problems that affect your health, dietary intake, and quality of life^[15].

If you experience constant dryness, difficulty swallowing, or frequent cavities, you should contact your doctor or dentist. Early treatment can help prevent complications and improve your quality of life^[4].