Related conditions:
Tooth decay, canker sores and mouth sores, geographic tongue, gum sensitivity, gingivitis, halitosis (bad breath), dysphagia (difficulty swallowing), dry eyes, nasal dryness, nosebleeds
Definition:
Dry mouth is an insufficient amount of saliva and moisture that would otherwise naturally lubricate and rinse the oral cavity.
Risk factors: Many medications (prescription and over the counter) can cause dry mouth: antihistamines, antidepressants, antianxiety drugs, antihypertensive drugs, decongestants, sinus medications, pain medications, asthma and allergy medications, diuretics, and Parkinson’s medications. Chemotherapy or radiation treatments (particularly radiation therapy to the head and neck regions) also can cause this condition. Diseases and disorders that increase the risk of dry mouth include Parkinson’s disease, thyroid disorders, cancer, diabetes, human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), Sjögren syndrome, stroke, systemic lupus erythematosus (SLE), increased progesterone levels, and decreased estrogen levels. Other factors that amplify dry mouth include smoking tobacco or marijuana, hormone imbalances, mouth breathing, dry air environment, drinking strong citrus juices, vitamin or mineral deficiencies, anxiety and stress, alcohol consumption, high fevers, stones or tumors in the salivary ducts, hyperventilation, nasal obstruction, vomiting or diarrhea, and excessive sweating.
Etiology and the disease process: Saliva contains enzymes that help break down and rinse away food particles and liquids. It also neutralizes acids and sugars in the mouth. Inadequate lubrication causes a dry mouth environment. When a person loses the ability to produce the normal amount of saliva, plaque and bacteria build up and adhere to the teeth, causing rapid, extensive decay and serious oral infections. Oral infections have the potential to interfere with planned cancer treatment therapies.
Incidence: In general, dry mouth issues are more frequent in men; however, they also are more common in women during menopause and postmenopause. Dry mouth syndrome increases with the number of medications taken by an individual. Dry mouth can also be caused by an autoimmune disease called Sjögren syndrome. Approximately 4 million people are diagnosed each year with Sjögren syndrome. Approximately one-third to one-half of all cancer patients develop dry mouth complications because of radiation therapy, chemotherapy, and medication treatments.
Symptoms: Symptoms include a dry or fissured tongue, a dry oral cavity, chapped or cracked lips, difficulty swallowing, increased risk of tooth decay, increased chance of mouth sores, bad breath (halitosis), increased gum sensitivity, gingivitis, bleeding gums, a burning sensation in the mouth, a dry throat, dry eyes, and increased oral infections.
Screening and diagnosis: The patient is the first to notice symptoms. Friends and relatives often hear the lack of saliva within the patient’s speech and notice an unpleasant mouth odor. Dentists often note the dryness during dental exams and discover an increase in the number of cavities.
Treatment and therapy: Patients should drink plenty of liquids during meals and sip on water between meals to help rinse away food particles, make it easier to swallow, and neutralize any oral debris. Sipping on soda all day or sucking on sugary hard candies in an effort to alleviate dry mouth should be avoided. Instead, patients may eat sugar-free candy or chew sugarless gum to help stimulate their natural salivary secretions. They should also eat healthy foods including those with natural oils such as peanuts, peanut butter, and fish. Patients should avoid coffee and tea that have sugar or creamers added. They should stop smoking, avoid all tobacco products, and stop drinking alcohol. Patients should brush twice daily, floss after snacks and meals, and use alcohol-free fluoride mouth rinses. Some patients may need hormone replacement therapy (HRT) or vitamin supplements. They may also use artificial saliva substitutes or fluoride gels such as PreviDent, Biotene, or PerioGard.
Prognosis, prevention, and outcomes: Dry mouth can be a temporary or permanent situation depending on its cause. Radiation therapy can permanently damage salivary glands, and chemotherapy can cause saliva to become thick. Patients may reduce dry mouth symptoms by changing their medications; however, they should check with their doctor before changing or discontinuing any medications. Using water rinses, saliva substitutes, and fluoride rinses without alcohol will help alleviate dry mouth symptoms, strengthen teeth, and fight future tooth decay. Serious oral infections and extensive decay may result in loss of teeth and difficulty wearing dentures. Maintaining excellent oral hygiene is a challenge with dry mouth issues. More frequent dental exams and cleanings are necessary to check for decay. By avoiding the triggers that provoke dry mouth and using the recommended treatments, dry mouth may be manageable.
American Dental Association. ADA Guide to Dental Therapeutics. 4th ed. Chicago: Author, 2006.
Litin, Scott C., Jr., ed. Mayo Clinic Family Health Book. 3d ed. New York: HarperResource, 2003.
National Institutes of Health. Dry Mouth. NIH Publication 99-3179. Bethesda, Md.: Author, 1999.
Shafer, William G., Maynard K. Hine, and Barnet M. Levy. A Textbook of Oral Pathology. 4th ed. Philadelphia: W. B. Saunders, 1983.
Waal, Isaac van der. Diseases of the Salivary Glands Including Dry Mouth and Sjögren’s Syndrome: Diagnosis and Treatment. New York: Springer-Verlag, 1997.
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