HOW TO MANAGE DRY MOUTH?

Dry mouth (also known as xerostomia) is a condition where the mouth fails to produce sufficient saliva to perform its routine functions. Usually, the saliva keeps oral tissues moist and helps in the digestion of food. Its self-cleansing action helps remove food particles and neutralizes acids produced by bacteria in the mouth. This protects teeth from decay and helps maintain oral health. Decreased salivary flow in the mouth may cause difficulties while chewing, swallowing, and speaking. It also increases the risk of developing tooth decay, gum infection, and other oral infections.

Dry mouth is common among elderly individuals. Many individuals associate dry mouths with aging. However, it is not an age-related condition.

In this article, we discuss the causes, symptoms, diagnosis, and treatment of dry mouth.

What are the causes of dry mouth?

Healthy individuals may experience dry mouth at night. This is because of decreased saliva production at night. In addition, individuals with mouth breathing habits also develop dry mouth.

Here are some of the conditions that can cause dry mouth:

• Medications: Intake of medications such as antihistamines (anti-allergy), anti-hypertensives (to control blood pressure), antidepressants, antiepileptic (against seizures), antispasmodic drugs (for stomach cramps), and muscle relaxants may cause salivary glands (organs) to produce less saliva, causing dryness of the mouth.
• Nerve damage: Sometimes, injuries in the head and neck region can damage the nerves that signal salivary glands to produce saliva. This impacts the production of saliva in the mouth.
• Diseases: Presence of several conditions such as Sjögren's syndrome (Immune system disease causing dryness of eyes and mouth), HIV/AIDS, uncontrolled diabetes, hormonal imbalances, Hepatitis C, Parkinson’s disease, Alzheimer’s disease, cystic fibrosis (a genetic disease that causes lung infections) can cause dryness of the mouth.
• Aging: Dry mouth affects 30% of individuals above 60 years of age. This is due to the presence of comorbidities and the intake of several medications.
• Treatment of cancer: Dry mouth is one of the side effects of chemotherapy and radiotherapy used to cure cancers in the head and neck region. These therapies can directly damage the salivary glands and reduce saliva production. However, the damage is reversible. In case of prolonged treatment, salivary glands may get damaged permanently, increasing the risk of dry mouth for life. Even the use of radioactive iodine to treat thyroid cancer can damage salivary glands.
• Habits: Drinking alcohol, intake of tobacco, caffeine, and the use of recreational drugs can cause dry mouth.

What are the symptoms of dry mouth?

Here are commonly experienced symptoms of dry mouth:

• A sticky or dry feeling in the mouth
• Difficulty in chewing, swallowing, or talking
• Altered taste sensation
• Burning sensation in the mouth
• Cracked or peeling lips
• Dry or sore throat
• Bad breath
• Presence of infection in the mouth
• Presence of white patch (membrane) on tongue or inner cheeks
• Poor fitting of dentures in individuals with missing teeth (Dentures are removable appliances used to replace missing teeth)

How is dry mouth diagnosed?

Dry mouth can be diagnosed in the following ways:

• Medical history: A dentist will assess the individual’s medical history and enquire if they have diabetes, Sjogren’s syndrome, psychological disorders, HIV/AIDS, Hepatitis C virus, or underwent chemotherapy or radiation therapy. The dentist will further inquire if they have any difficulty talking, tasting, chewing, and swallowing food. He/she will also inquire if the individual has felt the need to sip water frequently or developed dryness of eyes along with joint pain.
• Clinical examination: During clinical examination, the dentist will examine the presence of cracks on the lips and any facial asymmetry in front of the earlobes or chin due to enlargement of salivary glands in these regions. He/she will touch these areas and look for the pooling of saliva or pus discharge from the opening of salivary glands present in the mouth. The tongue is examined for a white membrane-like structure and the presence or absence of taste buds. Further, the presence of multiple decays, gums or any other oral infections is determined.
• Radiological examination: The presence of decay in the teeth can be confirmed using intraoral x rays. Additionally, other radiographs may be recommended to check for stones in the salivary glands.
• Other examinations: Several diagnostic tests such as biopsy of salivary glands, salivary flow rate estimation, and microbial testing may also help in the diagnosis. Salivary flow (if unstimulated) less than 0.1ml/min or less than 0.7ml/min (if stimulated while chewing, talking, or tasting) is considered reduced salivary flow.

How to manage dry mouth?

In general, dry mouth can be managed to an extent by modifying an individual's lifestyle. Here are some recommendations advised by the dentist:

• Sip water or sugarless drinks frequently
• Chew on ice chips to keep yourself hydrated
• Chew sugar-free gums containing xylitol and mints to increase the salivation
• Use lip balms or other lubricants frequently to hydrate lips
• Maintain good oral hygiene by brushing and flossing teeth twice daily
• Visit a dentist for regular cleaning of teeth and fluoride application to reduce the risk of decay and oral infections
• Use fluoridated toothpaste or fluoride gel (if recommended) to prevent tooth decay
• Use a humidifier at night to reduce the dryness
• Avoid spicy, hard to chew, sugary, and sticky food items to reduce the risk of decay
• Avoid the intake of alcohol, alcohol-based mouth rinses, and tobacco
• Avoid caffeine as it increases the loss of fluid from the body and further enhances the dryness of mouth

However, treatment of dry mouth can vary based on the causes. Here are some common treatment options:

• Contact a physician to find alternatives to prescribed medications that cause dry mouth or to adjust the dose of drugs to reduce the side effect
• Take medications in the day instead of night and in small divided doses instead of a single large dose. This reduces dry mouth symptoms
• Take over-the-counter saliva substitutes, which help moisturize and lubricate the oral tissues. These substitutes are available in the liquid or gel form and provide temporary relief
• Use medications as prescribed by the dentist to increase the saliva flow. These medicines include pilocarpine and cevimeline. They can be used to manage dry mouth due to cancer therapy or Sjögren's syndrome
• Visit a dentist to diagnose the presence of oral infections (e.g., fungal infection-candidiasis) and treatment of damaged teeth and gums

If an individual experiences joint pain, dry eyes, or other systemic disorders along with dry mouth, then the dentist may refer him/her to the concerned specialists.

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References:

• Ying Joanna, N. D., & Thomson, W. M. (2015). Dry mouth – An overview. Singapore Dental Journal, 36, 12–17.
• Plemons JM, Al-Hashimi I, Marek CL, American Dental Association Council on Scientific A. Managing xerostomia and salivary gland hypofunction: Executive summary of a report from the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 2014;145(8):867-73.
• Wolff A, Joshi RK, Ekström J, et al. A guide to medications inducing salivary gland dysfunction, xerostomia, and subjective sialorrhea: A systematic review sponsored by the World Workshop on Oral Medicine VI. Drugs R D 2017;17(1):1-28.
• Lynge Pedersen AM, Belstrøm D. The role of natural salivary defences in maintaining a healthy oral microbiota. Journal of Dentistry 2019;80:S3-S12.
• National Institute of Dental and Craniofacial Research. Dry mouth (nih publication no. 14-3174). National Institutes of Health. https://www.nidcr.nih.gov/health-info/dry-mouth
• Auluck A. How do I Manage a Patient with Xerostomia/Dry Mouth?. Journal (Canadian Dental Association). 2016 May;82:g11.
• Turner, M. D., & Ship, J. A. (2007). Dry Mouth and Its Effects on the Oral Health of Elderly People. The Journal of the American Dental Association, 138, S15–S20.
• https://www.aaom.com/dry-mouth
• https://www.mouthhealthy.org/en/az-topics/d/dry-mouth
• https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/xerostomia

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