Xerostomia (zeer-o-STOE-me-uh), refers to a condition in which the salivary glands in your mouth don’t make enough saliva to keep your mouth wet. Dry mouth is often due to the side effect of certain medications or aging issues or as a result of radiation therapy for cancer. Less often, dry mouth may be caused by a condition that directly affects the salivary glands.
There are three pairs of relatively large, major salivary glands:
- Parotid glands. Located in the upper part of each cheek, close to the ear. The duct of each parotid gland empties onto the inside of the cheek, near the molars of the upper jaw.
- Submandibular glands. Under the jaw. They have ducts that empty behind the lower front teeth.
- Sublingual glands. Beneath the tongue. They have ducts that empty onto the floor of the mouth.
Causes of Dry Mouth/Xerostomia
There are several causes of dry mouth, also called xerostomia. These include:
There are over 1,800 medications, both prescription and over-the-counter, that have a side effect of dry mouth. Some of the most commonly prescribed include:
- ADHD medications (methylphenidate and amphetamines)
- Narcotic pain relievers
- SSRI antidepressants
- Tricyclic antidepressants
- Sleep medications
- Muscle relaxants
- Everyday medicines, such as cold remedies and antihistamines
Age – While dry mouth tends to be more common in the elderly, it is not necessarily due to their age, but rather the fact that this population tends to take several medications. Half of all Americans aged 60 years or older take three or more prescription medications on a regular basis. Older people are also more likely to be affected by cancer and Sjögren’s syndrome, both of which cause dry mouth.
Sjögren’s Syndrome – Dry mouth is one of the more prominent symptoms of Sjögren’s syndrome. This disease affects the body’s immune system and attacks the tear and salivary glands. Females are more likely to suffer from this chronic condition as 90% of people with the disease are women.
Diabetes – One of the most common oral health problems of diabetics is dry mouth because diabetics have an increased risk of dehydration due to higher blood glucose levels. While thirst may be the first indicator people recognize, dry mouth and dry eyes are also a main symptom of dehydration. Learn how to treat dry mouth from diabetes.
Cancer and Treatment – Chemotherapy or radiation treatments can be damaging to the salivary glands of neck and head cancer patients specifically. Although some may regain partial salivary production after the first year of their treatment, many will continue to suffer from long-term dry mouth symptoms, especially if radiation was directed at their salivary glands.
Parkinson’s disease – Some people with Parkinson’s disease experience dry mouth because they swallow repeatedly, which uses up the saliva that is needed to be comfortable. Dry mouth may also be caused by some of the medications for Parkinson’s disease, particularly
Cancer treatment – Radiotherapy (radiation therapy) to the head and neck can damage the salivary glands, resulting in less saliva being produced. Chemotherapy can alter the nature of the saliva, as well as how much of it the body produces.
Injury or surgery – This can result in nerve damage to the head and neck area can result in dry mouth.
Nerve damage – An injury or surgery that causes nerve damage to your head and neck area can result in dry mouth.
Tobacco – Either chewing or smoking tobacco increases the risk of dry mouth symptoms.
Dehydration – This is caused by lack of sufficient fluids.
Exercising or playing in the heat – The salivary glands may become dry as bodily fluids are concentrated elsewhere in the body. Dry mouth symptoms are more likely if the exercise or playing continues for a long time.
Some health conditions, illnesses, and habits can cause dry mouth, such as:
- anxiety disorders
- Parkinson’s disease
- poorly controlled diabetes
- Sjögren’s syndrome
- sleeping with the mouth open
- stroke and Alzheimer’s disease, although these are more likely to cause a perception of dry mouth even when the salivary glands are functioning appropriately
Symptoms of Dry Mouth/ Xerostomia
True hyposalivation may give the following signs and symptoms:
Dental caries (xerostomia related caries) – Without the anticarcinogenic actions of saliva, tooth decay is a common feature and may progress much more aggressively than it would otherwise (“rampant caries”). It may affect tooth surfaces that are normally spared, e.g., cervical caries and root surface caries. This is often seen in patients who have had radiotherapy involving the major salivary glands, termed radiation-induced caries. Therefore it’s important that any products used in managing dry mouth symptoms are sugar-free, as the presence of sugars in the mouth support the growth of oral bacteria, resulting in acid production and development of dental caries
- Acid erosion – Saliva acts as a buffer and helps to prevent demineralization of teeth.
- Oral candidiasis – A loss of the antimicrobial actions of saliva may also lead to opportunistic infection with Candida species.
- Ascending (suppurative) sialadenitis – an infection of the major salivary glands (usually the parotid gland) that may be recurrent. It is associated with hyposalivation, as bacteria are able to enter the ductal system against the diminished flow of saliva. There may be swollen salivary glands even without acute infection, possibly caused by autoimmune involvement.
- Dysgeusia – altered taste sensation (e.g., a metallic taste)and dysosmia, altered sense of smell.
- Intraoral halitosis – possibly due to increased activity of halitogenic biofilm on the posterior dorsal tongue (although dysgeusia may cause a complaint of nongenuine halitosis in the absence of hyposalivation).
- Oral dysesthesia – a burning or tingling sensation in the mouth.
- Saliva that appears thick or ropey.
- Mucosa that appears dry.
- A lack of saliva pooling in the floor of the mouth during the examination.
- Dysphagia – difficulty swallowing and chewing, especially when eating dry foods. Food may stick to the tissues during eating.
- The tongue may stick to the palate, causing a clicking noise during the speech, or the lips may stick together.
- Gloves or a dental mirror may stick to the tissues.
- Fissured tongue with atrophy of the filiform papillae and a lobulated, erythematous appearance of the tongue.
- Saliva cannot be “milked” (expressed) from the parotid duct.
- Difficulty wearing dentures, e.g., when swallowing or speaking. There may be generalized mucosal soreness and ulceration of the areas covered by the denture.
- fungal infections in the mouth, such as thrush
- glossodynia, or a painful tongue
- increased need to drink water, especially at night
- inflammation of the tongue, tongue ulcers
- lipstick sticking to teeth
- more frequent gum disease
- more tooth decay and plaque
- problems speaking
- problems swallowing and chewing – especially dry and crumbly foods, such as crackers or cereals
- problems wearing dentures – problems with denture retention, denture sores, and the tongue sticking to the palate
- sialadenitis, a salivary gland infection
- a sore throat
- sticky saliva
- stringy saliva
- Mouth soreness and oral mucositis.
- Lipstick or food may stick to the teeth.
- A need to sip drinks frequently while talking or eating.
- Dry, sore, and cracked lips and angles of the mouth.
Diagnosis of Dry Mouth/Xerostomia
Tests vary depending on the condition thought to be causing the problem.
- Images of the glands can be seen using ultrasound, MRI scan, and CT scans of the glands.
- The ducts of the mouth can be investigated using an x-ray called a sialogram.
- A salivary gland biopsy can be used to diagnose problems with the salivary glands.
- Salivary flow rate — In this test, the amount of saliva produced during a specified amount of time may be measured. The test is non-invasive and painless.
- Scintigraphy — Performed in the hospital, this test measures the rate at which a small amount of injected radioactive material is taken up from the blood by the salivary glands and secreted into the mouth. It is another method to measure salivary flow rate.
- Biopsy of minor salivary glands — A small, shallow incision is made inside the lower lip to remove at least four of minor salivary glands. A pathologist then examines them for changes characteristic of the salivary component of Sjögren’s syndrome.
- Sialometry –This is a simple procedure that measures the flow rate of saliva. Collection devices are placed over duct orifices of the saliva glands, and saliva production is stimulated with citric acid.
- Saliography – This is a radiographic examination of the salivary glands and ducts. It may be useful in identifying salivary gland stones and masses.
- Biopsy – A small sample of salivary gland tissue is taken. Often used in the diagnosis of Sjögren’s syndrome. If malignancy (cancer) is suspected, the doctor may also order a biopsy.
Treatment of dry mouth/Xerostomia
- Change the medication producing the dry mouth
- Sipping water or melting ice in the mouth
- Prescription dentifrices such as President and Clinpro 5000
- OTC and Internet dentifrices containing higher amounts of xylitol (10% to 36%) to control acidophilic bacteria (Tom’s of Maine, Spry by Xlear)
- OTC dentifrices containing triclosan or sodium bicarbonate (both have antimicrobial properties)
- Refrain from using dentifrices containing the drying agent SLS
- OTC fluoride or xylitol mouth rinses (ACT Dry Mouth Mouthwash)
- Regular use of xylitol-containing (first listed ingredient) products that mechanically stimulate salivary flow and discourage S. mutans (TheraGum by 3M ESPE and X-Pur mints and gum by Oral Science, Canada)
- OTC saliva substitutes that stimulate, moisten, and lubricate oral tissues, palliative products that contain carboxymethylcellulose (CMC), calcium and phosphorus, fluoride and other typical salivary ions (Biotene products by GlaxoSmithKline)
- Gels that neutralize oral pH (Dry Mouth Gel, GC America) and lozenges (SalivaSure) with citric acid that chemically stimulate salivary flow (available on the Internet, several manufacturers and distributors)
- Adhesive tablets applied to the palate (OraMoist by Quantum Health and XyliMelts by Oral Health) contain xylitol, a lubricant, oral enzymes, buffering compounds, and salivary secretion inducers
- Application of vitamin E-containing ointment to dry lips
- OTC (Oasis and Salivart Spray) and prescription artificial saliva (Neutra-sal) products that contain buffering and flavoring agents but no digestive enzymes or proteins
- Customized night trays with remineralizing agents (several products available)
- Prescription sialagogue medications such as pilocarpine (Salagen), cevimeline HCl (Evoxac), anethole trithione (Sialor) and bethanechol (Urecholine). These drugs enhance secretion for a few hours. Patients should increase fluid intake during use. NOTE: The ADA does not currently recommend the use of salivary-stimulating drugs due to a lack of quality evidence-based research on the efficacy of drugs that increase the flow rate of saliva.
- Pilocarpine- Pilocarpine is a cholinergic parasympathomimetic agent with predominantly muscarinic M3 action that causes stimulation of residual-functioning exocrine glands. The tablets are indicated for the treatment of symptoms of dry mouth from salivary gland hypofunction caused by Sjögren’s syndrome or by radiotherapy for cancer of the head and neck. The time to reach peak concentrations following oral administration is approximately 1.25 hours.
- Pilocarpine- is contraindicated in patients with uncontrolled asthma, narrow-angle glaucoma or iritis. It is pregnancy category C. The most common side effects are increased sweating and gastrointestinal intolerance. Hypotension, rhinitis, diarrhea and visual disturbances can also occur. The recommended initial dose is one 5 mg tablet taken TID or QID;
- Cevimeline- Cevimeline is a cholinergic agonist with a high affinity for the muscarinic M3 receptors located on lacrimal and salivary gland epithelium, leading to an increase in exocrine gland secretions including saliva and sweat. It is indicated for the treatment of symptoms of dry mouth in patients with Sjögren’s syndrome. It is rapidly absorbed from the gastrointestinal tract, reaching peak concentrations in approximately 90 minutes without food
- Xylitol -has beneficial oral effects: bacteriostatic and moisturizer, while it boosts the anticaries and remineralizing effects of Sodium fluoride. Betaine, Allantoin, and Aloe vera, thanks to their anti-irritant, regenerative and healing effects on tissues,
The management of salivary gland dysfunction may involve the use of saliva substitutes and/or saliva stimulants:
Saliva substitutes – These are viscous products which are applied to the oral mucosa, which can be found in the form of sprays, gels, oils, mouthwashes, mouth rinses, pastilles or viscous liquids. This includes SalivaMAX, water, artificial salivas (mucin-based, carboxymethylcellulose-based), and other substances (milk, vegetable oil)
- Mucin Spray: 4 Trials have been completed on the effects of Mucin Spray on Xerostomia, overall there is no strong evidence showing that Mucin Spray is more effective than a placebo in reducing the symptoms of dry mouth.
- Mucin Lozenge: Only 1 trial (Gravenmade 1993) has been completed regarding the effectiveness of Mucin Lozenges. Whilst it was assessed as being at high risk of bias, it showed that Mucin Lozenges were ineffective when compared to a placebo.
- Mucoadhesive Disk: These disks are stuck to the palate and they contain lubricating agents, flavouring agents and some antimicrobial agents. One trial (Kerr 2010) assessed their effectiveness against a placebo disk. Strangely, patients from both groups (placebo and the real disk) reported an increase in subjective oral moistness. No adverse effects were reported. More research is needed in this area before conclusions are drawn.
- Biotene Oral Balance Gel & toothpaste: One trial has been completed (Epstein 1999) regarding the effectiveness of Biotene Oral Balance gel & toothpaste. The results showed that Biotene products were “more effective than control and reduced dry mouth on waking”.
Saliva stimulants – organic acids (ascorbic acid, malic acid), chewing gum, parasympathomimetic drugs (choline esters, e.g. pilocarpine hydrochloride, cholinesterase inhibitors), and other substances (sugar-free mints, nicotinamide). Medications which stimulate saliva production traditionally have been administered through oral tablets, which the patient goes on to swallow, although some saliva stimulants can also be found in the form of toothpaste. Lozenges, which are retained in the mouth and then swallowed are becoming more and more popular. Lozenges are soft and gentle on the mouth and there is a belief that prolonged contact with the oral mucosa mechanically stimulates saliva production. Pilocarpine: A study by Taweechaisupapong in 2006 showed no ‘statistical significant improvement in oral dryness and saliva production compared to placebo’ when administering pilocarpine lozenges.Physostigmine Gel: A study by Knosravini in 2009 showed a reduction in the oral dryness and a 5 times increase in saliva following physostigmine treatment.
- Chewing gum increases saliva production but there is no strong evidence that it improves dry mouth symptoms.
- The Cochrane oral health group concluded ‘there is insufficient evidence to determine whether pilocarpine or physostigmine’ are effective treatments for Xerostomia. More research is needed.
- Detrol chewing gum (xylitol) – A study by Risheim in 1993 showed that when subjects had 2 sticks of gum up to 5 x daily, the gum gave subjective dry mouth symptom relief in approximately 1/3 of participants but no change in SWS (stimulated the whole saliva).
- Profilin lozenge (xylitol/sorbitol) – A study by Risheim in 1993 showed that when subjects had 1 lozenge 4 to 8 x daily, profilin lozenges gave subjective dry mouth symptom relief in approximately 1/3 of participants but no change in SWS (stimulated whole saliva)
How can I manage my symptoms of dry mouth/Xerostomia
- Drink liquids as directed. You may need to drink more water than usual. It may help to sip small amounts throughout the day. This will help keep your mouth moist. Do not drink caffeine or alcohol. Do not drink acidic juices such as tomato, orange, or grapefruit.
- Eat soft, moist foods. Choose foods that are cool or room temperature. Moisten dry foods with milk, broth, or other sauces. Healthy foods include fruits, vegetables, whole-grain bread, low-fat dairy products, beans, lean meats, and fish.
- Brush at least twice each day. This will help prevent tooth decay and cavities. You may need to brush after each meal as well. Use a soft toothbrush and fluoride toothpaste. Floss gently once each day. Use over-the-counter mouth rinses that help increase saliva. Do not use mouth rinses that have alcohol.
- Chew sugarless gum or suck on sugar-free candy. This will help increase saliva production.
- Use a cool mist humidifier. A humidifier will increase air moisture in your home. This may help moisten your mouth, especially at night.
- Rinse your mouth 4 times each day. Rinse after every meal. Use a mixture of salt and baking soda. Mix ½ teaspoon of salt and ½ teaspoon of baking soda in 1 cup of warm water.
- Do not smoke. Tobacco products can dry out your mouth. Do not use e-cigarettes or smokeless tobacco in place of cigarettes or to help you quit. They still contain nicotine. Ask your healthcare provider for information if you currently smoke and need help to quit.
Home Remedies for dry mouth /Xerostomia include
When our taste buds and nerve endings experience an extreme stimulant, the body’s natural response is to produce saliva. For example, when we eat something spicy, we begin to salivate in order to soothe the burning sensation, so if you’re suffering from dry mouth, take a bit of cayenne powder and rub it on your tongue or gums.
The citric acid found in lemons and lemon juice can quickly stimulate the production of saliva, and also protect your mouth from infections that can contribute to bad breath and other oral issues. You can rub a slice of lemon on your tongue, mix lemon juice with honey, or simply suck on a lemon slice to eliminate your dry mouth.
This is one of the oldest and most trusted remedies for dry mouth. Aloe vera juice is rich in antioxidants, nutrients, and naturally hydrating substances, and can also stimulate the production of saliva in the mouth. Furthermore, aloe vera can enhance the function of the tastebuds and protect you from oral infections.
Although dehydration isn’t the sole cause of dry mouth, it is certainly to blame some of the time. If you increase your daily intake of water, you’re much less likely to suffer from dry mouth, as it will increase the amount of saliva that your body produces, and also lubricates the throat, gums, and lips, preventing some of the more uncomfortable side effects of xerostomia.
There are a number of natural moisturizing properties of grapeseed oil that makes it very good at preventing or eliminating dry mouth symptoms. Simply rub a small amount of grapeseed oil on your gums and on your tongue, and it should keep your mouth hydrated and moisturized for hours!
Get a Humidifier
If you regularly wake up in the middle of the night suffering from dry mouth, it may be because the environment of your bedroom is too dry. Getting a humidifier can be a simple and effective way to handle dry mouth and ensure that you have restful, undisturbed sleep.
If you find yourself suffering from xerostomia and are also taking a new medication, try speaking to your doctor about alternative prescriptions that don’t have dry mouth as such a consistent symptom, as those medications are very commonly the root cause of your suffering.
Develop a Sweet Tooth
Anecdotal evidence suggests that sucking on hard candy or chewing on sugar-free gum can quickly stimulate the production of saliva, so if you feel a bout of cotton mouth coming on, simply pop a piece of candy and the problem should clear itself up in no time!
Change Your Breathing Pattern
One of the quickest ways to dry out your mouth is to continually breathe through your mouth. If you are constantly bringing dry air into your mouth and throat, that air will rob you of hydration, thus drying out your mouth. If you can consciously try to breathe through your nose and out through your mouth, you are far less likely to experience dry mouth.
All tobacco products dry out the mouth, so if you’re a regular smoker, or chew tobacco, don’t be surprised if you suffer from dry mouth. The best way to eliminate the problem, obviously, is to cease all use of tobacco products, not only for the sake of your xerostomia, but also the many other health risks that smoking and tobacco use incurs.
Reduce Caffeine Intake
Studies have shown that caffeine can dehydrate the body and also dry out the mouth, so eliminating coffee, or at least cutting back to one cup a day, should keep your mouth properly salivated all day.
Limit Alcohol Consumption
There is a good reason why you feel so thirsty and weak after a long night of drinking. Alcohol dehydrates the body faster than almost any other substance, so if you regularly suffer from xerostomia, your alcohol intake is certainly not helping.
- Arsenic Alb – Accompanied with a thirst for small quantities of water at short intervals.
- Bryonia – with a thirst for large quantities of water, dryness from mouth to rectum.
- Nux mosch – Great dryness, tongue so dry that adheres to the roof of the mouth.
Saliva seems like cotton, throat dry,stiffened.
- Lachesis – Dryness of mouth.
the patient is unable to protrude his tongue
- Nux vomica
Breath offensive after meals in the morning.
breath offensive in the evening.
- Auram met
breath offensive in girls at puberty.
- Arum Trip
Putrid odor from the mouth.
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