Dry
Mouth (Xerostomia)
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Do you feel the
need to moisten your mouth frequently?
Does your mouth feel dry at mealtime?
Do
you have less saliva than you once did?
Do you have difficulty swallowing?
Do
you have trouble eating dry foods such as crackers or toast?
Do
you have pain in
the lining of your mouth?
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Does
your mouth feel like a desert?
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picture to enlarge)
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If you answer
"yes" to these questions, you may be one of the many people who suffer
from dry mouth, or xerostomia (pronounced "zero-stoh'-me-ah").
Although
xerostomia is not a disease in itself, it is a symptom of certain diseases. Dry
mouth is also a common side effect of many medications and medical
treatments. Most cases of dry mouth are caused by failure of the salivary glands
to function properly. But in some people, the sensation of a dry mouth occurs
even though their salivary glands are normal.
Dry mouth is a
significant health problem because it can affect nutrition and psychological
well-being, while also contributing to tooth decay and other mouth infections.
Dry mouth also may signal more serious problems in the body. If you have a dry
mouth, you should be seen by a dentist to determine the cause of the symptom.
Consultation with a physician may be recommended by your dentist.
We
welcome patients who have problems with dry mouth (or other oral discomforts)
whether they call our office directly or are referred by their current dentist
or physician.
Why
is saliva important?
Saliva
has many important functions in the body. Each person needs adequate amounts of
healthy saliva to:
 | Limit the growth
to bacteria that cause tooth decay and other oral infections
| Preserve
teeth by bathing them with protective minerals that allow small, early cavities
to remineralize and heal
| Lubricate the
soft tissues lining the mouth to keep them pliable and make speaking and chewing
easier
| Dissolve
foods and allow us to experience their sweet, sour, salty, and bitter tastes
| Assist digestion
by providing enzymes that break down food
| Lubricate
food so it can be swallowed easily
| Cleanse the
teeth and mouth of food particles |
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What
causes dry mouth?
Changes in
salivary gland function, brought on by:
Medications
Over 400 commonly used drugs can cause the sensation of dry mouth. The main
culprits are the anti-hypertensives (for high blood pressure) and
anti-depressants. Both are prescribed for millions of Americans. Painkillers,
tranquilizers, diuretics, and over-the-counter antihistamines can also decrease
saliva flow or quality.
Cancer
treatment
Radiation therapy can permanently damage salivary glands if they are
in the field of radiation. Chemotherapy can change the composition of saliva,
creating a sensation of dry mouth. Of
the 1.2 million Americans diagnosed with cancer each year, about one-third
develop oral complications from their cancer treatment. These
complications can be so debilitating that doctors are forced to use lower, less
effective doses of cancer curing drugs, to postpone scheduled treatments, or
even discontinue cancer treatment entirely. Oral complications or disease
can also be a source of infections that interfere with cancer therapy or pose a
serious threat to patient survival. For
these reasons, cancer patients need a dentist as part of their team of treating
healthcare professionals. Dr. Fox has
experience and expertise in helping cancer patients while cooperating with their
treating physicians.
Diseases
Sjögren's syndrome is an autoimmune disorder whose symptoms include
dry mouth and dry eyes. Some Sjögren's patients also have a connective tissue
disorder, most commonly Fibromyalgia, Rheumatoid Arthritis or Systemic Lupus Erythematosus
(also called "Lupus" or "SLE").
Other
Conditions
Bone marrow transplants, endocrine disorders, nutritional deficiencies, anxiety,
mental stress, and depression can cause a dry mouth.
Changes not
related to salivary glands, such as:
Nerve
damage
Trauma to
the head and neck area from surgery or wounds can damage the nerves that supply
sensation to the mouth. While the salivary glands may be left intact, they
cannot function normally without the nerves that signal them to produce saliva.
Altered
perception
Conditions like menopause, chronic oral yeast infections, Alzheimer's disease, or stroke may change the ability to perceive
oral sensations.
Does aging
cause dry mouth?
Until recently
dry mouth was regarded as a normal part of aging. Researchers now know that
healthy older adults do not produce less saliva. When older people do experience
dry mouth, it is because they suffer from diseases that cause the condition, or
because they take medications that produce dry mouth as a side effect.
What happens
when you have dry mouth?
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Desert
Dunes
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picture to enlarge)
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Dry mouth caused
by malfunctioning salivary glands is associated with changes in saliva. The flow
of saliva can decrease, or the composition of saliva can change.
Patients
with dry mouth have varying degrees of discomfort. Some people feel a dry or
burning sensation in their mouths. A dry mouth may affect their ability to chew,
taste, swallow, and speak.
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Changes in saliva
also can affect oral and dental health. Cavities, tooth loss, and gum diseases
are typically more aggressive in people with dry mouth. Dry mouth also
promotes or worsens bad breath (halitosis). Oral yeast infections (candida
albicans) can also be an associated problem.
Severe cases of
dry mouth can result in cracking of the lips, slits at the corners of the mouth,
changes in the surface of the tongue, rampant tooth decay, ulceration of the
mouth's linings, and infection.
Is relief
available?
Yes, there is
hope. The first step is to consult a dentist with expertise in this area
and have a comprehensive oral examination. There are both in office
treatments and prescription medications that offer partial or even total relief.
Although there is
no single way to treat dry mouth, there are a number of steps you can follow to
keep teeth in good health and relieve the sense of dryness. These suggestions
will not correct the underlying cause of xerostomia, but may help you feel more
comfortable.
To preserve
your teeth:
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Brush
your teeth at least twice a day and use dental floss daily.
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Use
a toothpaste with the American Dental Association Seal of Approval that contains
fluoride.
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Avoid
sticky, sugary foods or brush immediately after eating them.
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See
your dentist at least three to four times a year for preventive care,
professionally applied prescription fluoride treatments, periodontal maintenance
care (if needed) and early treatment of cavities.
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Ask
you dentist if you should use a remineralizing solution or prescription-strength
topical fluoride preparation at home. |
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| Take frequent
sips of water or drinks without sugar. Pause often while speaking to sip some
liquid. Avoid caffeine-containing coffee, tea, and soft drinks. Sucking on ice
chips can also be helpful.
| Drink frequently
while eating. This will make chewing and swallowing easier and may increase the
taste of foods. Many patients find sipping skim milk (or other types of milk) a
big help.
| Keep a glass of
water by your bed for dryness during the night or upon awakening.
| Chew sugarless
gum. The chewing may produce more saliva. This should not be regularly relied
on, because sugarless gums can cause tooth decay.
| Eat sugarless
mints or hard sugarless candies, but let them dissolve in your mouth. Cinnamon
and mint are often most effective. But be cautious because sugarless candies or
mints CAN cause tooth decay.
| Place a small
piece of lemon rind or a cherry pit in your mouth. The sucking action helps
stimulate saliva.
| Avoid tobacco
and alcohol. Also avoid commercial mouthwashes, which usually contain
alcohol that will dry the mouth further.
| Avoid spicy,
salty, and highly acidic foods that may irritate the mouth.
| Ask your dentist
about using artificial salivas to help lubricate the mouth.
| Use a
humidifier, particularly at night. Keeping nasal passages and sinuses
moist helps promote breathing through the nose. If nasal passages get too
dry and mouth breathing occurs, the mouth will get extremely dry very quickly. |
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As many as two million Americans may suffer from Sjögren's syndrome.
The syndrome is commonly present but undiagnosed. Most afflicted patients
don't get the correct diagnosis for 6 to 9 years after symptoms start.
Two prescription
medications, Salagen (pilocarpine hydrochloride) and Evoxac (cevimeline), are
available to treat the dry mouth associated with Sjögren's. These
medications work by stimulating salivary gland nerve receptors (the M3
muscarinic receptors). Depending on the
nature and severity of symptoms, other medications include non-steroidal
anti-inflammatory drugs (NSAIDs), steroids, and immunosuppressive drugs.
Two
voluntary organizations have chapters in major cities around the country that
offer support for these patients. For further
information, contact:
Sjögren's
Syndrome Foundations, Inc.
366 North Broadway
Jericho, New York 11753
Tel (516) 933-6365
Fax (516) 933-6368
Information Requests: (800) 475-6473
National Sjögren's
Syndrome Association
3201 West Evans Drive
Phoenix, Arizona 85023
Links for More
Information
Sjögren's
Syndrome Foundation
Internet
Resources for Sjögren's
Syndrome
Wind-sculpted
sandstone
formations
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picture to enlarge)
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