Dry Mouth and Its Causes

Recently, another new drug product, Salagen (Pilocarpine HCI) was introduced to me by a drug representative. It was suggested it be used during and after radiation therapy. After reviewing the accompanying literature, I recognized that the majority of patients who I see in my practice suffer from dry mouth from more common causes.

Dry mouth is commonly reported by elderly patients, but the sensation is not always associated with decreased rate of salivary flow. In a recent study of 341 elderly individuals, drawn from a study on general health; stimulated and unstimulated salivary flow rates were measured and the participants were asked about their oral complaints relating to dry mouth and daily medication use.

Forty-six percent complained of dry mouth more often in the morning and at night. Twelve percent reported continuous dryness. Xerostomia was significantly more frequently reported in women (14%) than in men (6%). Women also had significantly more complaints as related to dry mouth, difficulty in speaking, burning sensation in the mouth, dry lips or skin and waking up at night to drink.

Dry mouth was noticed more often in patients who use analgesics and respiratory drugs. Frequent use of analgesics may indicate that a patient's tolerance of pain is low, suggesting that his or her threshold for feeling oral dryness is also low. Many of the medications used for respiratory illnesses may produce hyposalivation. Patients with dry mouth used diuretics and cardiovascular medications slightly more often than control; these drug classes may also decrease salivary flow.

To your patients who suffer from xerostomia some general recommendations include:

  • Carry a squirt bottle or water bottle so you'll always have water at hand.
  • Chew sugarless gum and candy
  • Rinse your mouth with baking soda before and after meals (1/4 teaspoon in a glass of water). Do not swallow the solution.
  • Avoid sugared of caffeinated drinks.
  • Stay away from alcohol and tobacco.
  • Avoid spicy, salty, or acidic foods that can irritate your mouth.
  • Avoid commercial mouthwashes which contain alcohol.
  • Discuss all medications with your physician.
Patients with xerostomia need to look after their dental health carefully. Saliva helps to reduce bacterial growth and protects the teeth. Additionally, the patient has an increase in plaque build up as well as a greater possibility of recurrent decay as well as cervical and root caries. More frequent visits to the dental office must be encouraged.

Xerostomia itself is not a serious medical condition, but it can indicate underlying systemic disease.