Dry Mouth

Dry mouth (medically known as xerostomia) is due to a reduction in saliva produced by salivary glands. Dry mouth is often a side effect of medication and less frequently is caused by a condition that damages or blocks salivary glands. Dry mouth can vary from being a slight nuisance to a major effect on general health and dental health. It affects appetite and taste, hence reducing ability to enjoy food and reducing nutrition.

Saliva has many roles including aiding digestion and enhancing our ability to taste food and allow easier swallow. Saliva prevents tooth decay by neutralising acids caused by bacteria, preventing growth of bacteria and washing away food pieces.

Causes

Medicines
Many medicines, including many over the counter medicines can cause dry mouth. These include some antidepressants and mood stabiliser drugs, drugs used for nerve pain (known as neuropathy), benzodiazepines (used to treat anxiety), some antihistamines (especially the ones that cause drowsiness), decongestants, pain killers and muscle relaxants.

Aging
The aging process does not cause dry mouth but older people have increased likelihood of conditions that cause dry mouth as well as increased likelihood to be taking medicines that cause dry mouth.

Cancer treatment

Both chemotherapy and radiation therapy change the quality of saliva and can reduce the amount and quality of saliva produced. Radiation treatment of the head and neck area is especially known to damage salivary glands thus reducing saliva. This may be reversible after treatment but in some cases it may cause permanent damage and hence ongoing dry mouth.

Nerve damage

A head or neck injury or surgery that results in nerve damage to the head or neck can lead to dry mouth.

Other health conditions

Dry mouth can be a result of some health conditions, including Sjogren's syndrome (an autoimmune disease which is a relation of arthritis and causes enlarged salivary glands, dry mouth, and dry eyes) and HIV/AIDS. Stroke and Alzheimer's disease can make a person perceive they have dry mouth despite normal functioning of the salivary glands. Snoring and breathing with an open mouth (while sleeping) can also contribute to dry mouth.

Smoking

Smoking can cause and exacerbate symptoms of dry mouth

Symptoms

While dry mouth is a nuisance, it is the symptoms and problems caused by dry mouth that has the major impact on people’s lives. When not enough saliva is being produced, problems caused will include: dryness of the mouth or throat; thick and stringy saliva; bad breath; changed taste sensations (or inability to taste flavours properly); problems with chewing; swallowing and speech problems; increased tooth decay and gum irritation and gum disease and problems wearing dentures including friction and pain.

 

Reduced saliva also leads to more oral problems including increased plaque, tooth decay and gum disease, mouth sores, fungal infection (candida) in the mouth, coated (discoloured) tongue, cracked lips, sores or skin splits occurring at the corners of the mouth. All these problems can lead to poor nutrition due to reduced ability to chew and swallow.

Treatment

Your doctor, dentist or pharmacist can advise on the condition. Initially an examination of your mouth, review of your medical history and details of medicines being taken (including over-the-counter medicines) will be required to rule out and determine possible causes.

Depending on the causes of dry mouth your doctor may need to change medicines that can cause dry mouth. In most cases there are alternative options that will not cause dry mouth. In some cases, it may not be possible to change the medicines causing the dry mouth as there may not be suitable alternatives and the benefits may outweigh the risks.

Mouth moisturising products

Options include mouth rinses, artificial saliva or moisturisers that lubricate the mouth. For severe dry mouth, options include prescription medication that works by stimulating saliva. Options include pilocarpine or cevimeline that stimulates saliva production.

There are over-the-counter saliva substitutes available from pharmacies including the Xerostom^® range of products. In Whelehans we find good results from Xerostom^®. Xerostom^® products (includes a gel, mouthwash, toothpaste and chewing gum) have been shown in studies to increase saliva flow by up to 200% and shown to relieve pain associated with dry mouth and improve taste and flavours. Xerostom has an acid free lemon flavour that is pleasant to take and does not cause any burning sensation (unlike some lemon flavoured products); this is especially important to cancer sufferers as the mouth is particularly sensitive due to chemotherapy and radiation treatment.

 Other Tips

Sip water or sugar free drinks regularly to moisten mouth and drink water during meals as it will help make chewing and swallowing easier.

Use sugar-free chewing gum or suck sugar-free hard sweets. Bear in mind however that xylitol is often a sugar substitute in sugar-free products and it can bring on diarrhoea and cramps if taken in large amounts.

 Aim to breathe through the nose, not the mouth. Treatment for snoring may be recommended as snoring causes breathing through the mouth during the night. A room humidifier may also help as it will add moisture to the air while you sleep. Regular moisturisation of the lips will soothe dry or cracked areas. Because of increased risk of dental problems, regular check-ups from your dentist are recommended.

What to avoid?

Avoid substances that can exacerbate dry mouth including caffeine and alcohol (these can cause dryness and irritation), avoid mouthwashes containing alcohol;  avoid salty and dry food; stop smoking and  ask your pharmacist what medicines to avoid including over the counter medicines that can cause dry mouth (such as antihistamines and decongestants).

Dental Advice event

Whelehans are holding a dental advice event on Friday October 3^rd where you will be able to get expert advice on dental hygiene, teeth whitening and dry mouth from an expert from Swordfish Medical. Call in for free expert dental advice and there will be great offers on the day.

Disclaimer: Information in this article is general; consult with your healthcare professional before making any changes recommended

This article is shortened. For more detailed information, logon to www.whelehans.ie or contact Whelehans at 044 93 34591 or info@whelehans.ie and we will forward you a more detailed copy for free

By Eamonn Brady MPSI, pharmacist and owner of Whelehans Pharmacy, 38 Pearse St, Mullingar