Dry mouth, also known as xerostomia, is due to a lack of saliva in the mouth. Stress, aging, taking medication, poor hydration, oral problems, chronic diseases… several factors can explain the phenomenon.
On average, a human produces between 1 and 1.5 liters of saliva per day. This saliva is used to protect our mucous membranes and gums from infectious agents (bacteria, viruses, and fungi), but also preserve the enamel of our teeth, allow the perception of taste, facilitate chewing, swallowing, digestion, and even speech.
Generally benign, the feeling of dry mouth can therefore have a significant impact on the quality of life. Why is dry mouth anyway? What are the causes? Does this sensation only occur at night?
Let’s take a look together.
What is xerostomia (dry mouth)?
Dry mouth (xerostomia) is linked to a decrease in the amount of saliva produced (hyposialia) and/or a change in the composition of the saliva (when the saliva becomes more viscous, for example). It may be temporary or settle in more permanently. Depending on its causes, it manifests itself in isolation or in combination (with dry eyes or dry vagina, for example).
Symptoms of dry mouth
Xerostomia can be accompanied by several symptoms, the appearance of which varies from person to person:
- A feeling of having a sticky and dry mouth and/or throat (especially at night),
- The appearance of cracks on the lips,
- The abnormally red coloring of the tongue,
- A burning sensation or irritation in the mouth, especially when eating spicy food,
- A greater feeling of thirst
Other less typical symptoms include:
- Decreased taste perception (dysgeusia),
- Difficulty chewing and/or swallowing (dysphagia),
- Speech disorders with speech problems (dysphonia),
- Or even difficulty in wearing an orthodontic appliance or a dental prosthesis.
What are the consequences of xerostomia (dry mouth)?
More or less disabling conditions can occur if the dry mouth persists:
- Bad breath (halitosis)
- Difficulty swallowing, detecting flavors, or even a change in smell (anosmia),
- Greater sensitivity to the development of bacteria, the formation of cavities or gingivitis,
- The persistence of painful cracks at the corners of the lips or in the mouth.
Causes of Dry Mouth
The decrease in saliva production (hyposialia) can be linked to a lack of hydration (easily correctable) but also to a disturbance or more or less significant destruction of the salivary glands. Several reasons can explain this phenomenon:
- Aging: with age, the salivary glands make less saliva, and the feeling of dry mouth becomes almost permanent.
- Dehydration: After age, dehydration is often the main cause of dry mouth. This often happens during strenuous physical activity, hot weather, or when the person generally does not drink enough water.
- Breathing through the mouth: when you breathe through your mouth saliva can dry out. Many people who sleep with their mouths open suffer from dry mouth when they wake up.
- Dry air: Especially in winter, the dry heating air irritates the mucous membranes of the respiratory tract. A dry nose, reddened eyes, and dry mouth are the consequences.
- Salivary gland tumors: Both malignant and benign salivary gland tumors can restrict the capacity of glands to function. Dry mouth is one of the potential symptoms.
- Stress & anxiety: When you’re stressed, depressed, or anxious, your brain sends a signal to your salivary glands, leading you to produce less saliva. Breathing problems can also be caused by stress, sadness, or anxiety. This can also dry up your mouth.
- Fever or diarrhea: If you are sick, you can lose a lot of fluids. You can also feel this dehydration in your mouth.
- A vitamin or fluid deficiency: If you do not get enough vitamins through your diet or do not drink enough water, this can cause a dry mouth.
- Hormonal fluctuations: During puberty, pregnancy, or menopause you may suffer from dry mouth.
- Medications: taking medication (antihistamines, anxiolytics, antidepressants and neuroleptics, diuretics, certain analgesics, antispasmodics, antihypertensives, antiparkinsonian drugs, etc.) can make your mouth dry.
- Heavy consumption of alcohol or tobacco: If you drink or smoke frequently or gargle regularly with an alcohol-based mouthwash, your oral tissues may get dry and itchy.
- Certain chronic or autoimmune diseases: finally, dry mouth can occur for a short time after radiotherapy to the head and/or neck or after surgical removal of one or more salivary glands.
- Metabolic diseases: Especially diabetes mellitus is initially manifested by non-specific symptoms such as frequent urination, a strong feeling of thirst and dry mouth, difficulty concentrating, or headaches.
- Sialadenitis: This inflammatory condition of the salivary glands is characterized by dry mouth. Bacteria, viruses, sarcoidosis, and the aforementioned Sjogren’s disease are all possible causes. Sialadenitis can also be caused by radiation therapy for malignancies in the head and neck region.
- Irradiation: Radiation therapy for head and neck cancers frequently causes damage to the salivary glands. The tissue might become inflamed (sialadenitis) or become permanently damaged. The mouth can become chronically dry, and people who are impacted may have taste problems or tongue burning.
- Diabetes insipidus: This condition is related to diabetes mellitus but is not the same. Urine is discharged in large amounts due to a hormonal imbalance. Dry mouth and a high sense of thirst are symptoms of the severe water loss that results.
- Sialadenosis: a painless enlargement of the salivary glands on both sides that might decrease salivation. The causes are many and include everything from eating problems to drinking to hormone imbalances.
Types of drugs that can cause dry mouth
Many drugs can affect the autonomic nervous system, which is responsible for controlling saliva production. With the following drugs, dry mouth occurs particularly often as a side effect:
- Antihypertensive drugs: these drugs reduce blood pressure and are therefore prescribed for high blood pressure (hypertension). They include beta-blockers, ACE inhibitors, dehydrating drugs (diuretics), as well as calcium antagonists.
- Painkillers: strong agents from the group of opioids cause dry mouth.
- Antiparkinsonians: some dopamine agonists used to treat Parkinson’s diseases cause dry mouth.
- Many medications have the potential to influence the autonomic nerve system, which is in charge of saliva production. The following medications cause dry mouth more frequently as an adverse effect:
- Antihypertensive drugs: these medications lower blood pressure and are used to treat high blood pressure (hypertension). Beta-blockers, ACE inhibitors, dehydrating medicines (diuretics), and calcium antagonists are among them.
- Opioids (strong painkillers): opioids are a class of drugs that induce dry mouth.
- Antiparkinson drugs: dry mouth is a side effect of certain dopamine agonists used to treat Parkinson’s disease.
- Antihistamines: these are active chemicals used to treat allergies. As a side effect, they might cause a dry mouth.
- Anticholinergics: these are medicines that block the function of acetylcholine, the parasympathetic nervous system’s principal messenger (“antagonist” of the sympathetic nervous system). They’re used to treat asthma and irritable bladder, among other things, with dry mouth as a possible side effect.
- Cytostatics: these are medicines that are given to cancer patients as part of their chemotherapy. They have the ability to stop fast-growing cells from multiplying and expanding (such as cancer cells). Dry mouth is a common unfavorable side effect.
- Antiepileptics: these are medications that are used to treat epilepsy. They, too, are capable of causing dry mouth.
- Antiemetics: nausea and vomiting medications can induce dry mouth.
- Psychotropic drugs: some antidepressants (antidepressants) and anxiety medications (neuroleptics) can cause dry mouth.
- Illicit substances: tetrahydrocannabinol (THC), the active component in cannabis, as well as other illegal drugs like heroin, cocaine, or ecstasy (MDMA), decrease salivary gland function. The mouth becomes dry as a result of this.
Tips to prevent or cure dry mouth
Review your medications
Medications are the most common cause of dry mouth. Simply discontinuing the medication is usually not an option. In this case, you should talk to your doctor to discuss potential solutions. For example, it might be better to take the meds at a different time, or he or she might consider changing the meds or reduce the dosage.
Furthermore, the doctor might prescribe some medications that can stimulate salivation. Unfortunately, such drugs are usually worse than the disease itself. They activate all glands, including the sweat glands, and partially cause cardiac arrhythmias. Seek advice from your doctor.
Use artificial saliva
If you produce no saliva or significantly too little saliva, artificial saliva can help. Although it does not work as well as natural saliva, it can at least provide relief. There is a thick gel that you apply under the tongue and on the palate. This is well suited for the night. During the day, a mouth spray can help keep your mouth moist.
It is believed that drinking water is a good remedy if your mouth feels constantly dry. But if saliva production is too low, you’ve probably noticed yourself that drinking water has only a limited effect. You feel relief for a moment, but after a minute the effect is already over. Fortunately, there are ways to promote saliva production. Chewing movements help to make saliva. For example, chew on sugar-free chewing gum. Sugar-free sweets will increase saliva production, especially products with a sour taste.
Take good care of your teeth
If you suffer from dry mouth, caries will form faster. Saliva helps maintain acidity in the mouth and protects against tooth decay and acid-induced degradation of tooth enamel. Go to the dentist more often and for professional tooth cleaning with a dental hygienist. Limit meals to three main and three snacks. Then brush your teeth with fluoride toothpaste. A neutral fluoride mouth rinse also reduces the risk of caries.
Drink during the meal
Drinking during a meal was previously discouraged. It was believed that important enzymes in saliva would then not work properly, which would be very unhealthy for digestion. But now, we know better. The role of these enzymes is limited and so there is nothing wrong with drinking some soup, milk, or water when eating. This makes the food mushier, does not stick in the mouth, and is easier to swallow.
Do not hesitate to contact your doctor!
If you are taking any medication (antihistamines, antidepressants, diuretics, certain analgesics, anxiolytics, etc.), check the list of side effects. If there is any mention of dry mucous membranes, discuss this with your doctor. Saliva substitutes or an Anethole trithione medication may be offered.
If you have ruled out all of the above conditions, it may be an autoimmune disease. This is why the advice of a healthcare professional is essential. Besides the discomfort, the dry mouth can be the symptom of a much more serious condition.
The feeling of “dry mouth”, or xerostomia, is due to a lack of saliva. The amount of saliva produced drops (hyposialia). Various symptoms then appear: increased thirst, oral problems, or even difficulty speaking or absorbing food.
Several mechanisms can be at the root of the decrease in saliva production (dehydration, more or less destruction of the salivary glands or disruption in their functioning, certain diseases, etc. Stress can also cause a feeling of dry mouth. This common, short-lived phenomenon goes away on its own after the stressful episode.
If you suffer from dry mouth, feel free to brush your teeth regularly with fluoride toothpaste, or use a fluoride mouthwash to prevent tooth decay. It is recommended to avoid sugary or acidic foods and drinks in order to prevent the appearance of cavities. Regular consultation with a dentist is necessary to detect and treat infections that might arise more easily.