Dry Mouth

In people with dry mouth, certain symptoms and characteristics are cause for concern. They include

People who have warning signs should see a doctor right away. People with extensive tooth decay should have a dental examination. People with a dry mouth but no warning signs and who otherwise feel well may see their doctor within a week or so.

Doctors first ask questions about the person’s symptoms and medical history. Symptoms of dry or irritated eyes, dry skin, rash, and/or joint pain raise the possibility of Sjögren syndrome Sjögren Syndrome Sjögren syndrome is a common autoimmune connective tissue disorder and is characterized by excessive dryness of the eyes, mouth, and other mucous membranes. White blood cells can infiltrate... read more . Doctors also ask about a history of past or current radiation treatment, head and neck trauma, and a diagnosis of or risk factors for HIV infection. Doctors need to know all the drugs a person is taking to find out whether any are causing the dry mouth.

Doctors then do a physical examination. The physical examination is focused on the mouth, to see the degree of dryness. If the degree of dryness is unclear, doctors can hold a tongue depressor against the inside of the cheek for 10 seconds. If the tongue depressor falls off immediately when released, the flow of saliva is considered normal. If there is difficulty removing the tongue depressor, the flow of saliva is not normal. In women, the lipstick sign, where lipstick sticks to the front teeth, may be a useful indicator of dry mouth.

Doctors also examine the mouth for the presence of any sores caused by the fungus Candida albicans and check the condition of the teeth (for instance, whether there are any cavities in unusual places). Unexpectedly severe and rapid tooth decay may be a sign of illicit drug use, particularly methamphetamines Amphetamines Amphetamines are stimulant drugs that are used to treat certain medical conditions but are also subject to abuse. Amphetamines increase alertness, enhance physical performance, and produce euphoria... read more .

What doctors find during the history and physical examination often suggests a cause of the dry mouth (see table Some Causes of Dry Mouth Some Causes of Dry Mouth ) and the tests that may need to be done. If the dry mouth began shortly after a new drug was started, doctors often try stopping the drug to see whether symptoms go away.

Sometimes, doctors test how well the salivary glands are functioning by measuring the flow of saliva (a test called sialometry). People chew paraffin or apply citric acid to the tongue to stimulate the flow of saliva, and then doctors collect the saliva. Measuring the flow of saliva can help doctors determine whether the dry mouth is getting better or worse.

If doctors are unable to determine the cause of dry mouth, people should usually undergo a biopsy (removal of a sample of tissue for examination under a microscope) of a minor salivary gland on the lower lip to detect Sjögren syndrome Sjögren Syndrome Sjögren syndrome is a common autoimmune connective tissue disorder and is characterized by excessive dryness of the eyes, mouth, and other mucous membranes. White blood cells can infiltrate... read more , sarcoidosis Sarcoidosis Sarcoidosis is a disease in which abnormal collections of inflammatory cells (granulomas) form in many organs of the body. Sarcoidosis usually develops in people aged 20 to 40 years, most often... read more , amyloidosis Amyloidosis Amyloidosis is a rare disease in which abnormally folded proteins form into collections called amyloid fibrils that accumulate in various tissues and organs, sometimes leading to organ dysfunction... read more , tuberculosis, Tuberculosis (TB) Tuberculosis is a chronic contagious infection caused by the airborne bacteria Mycobacterium tuberculosis. It usually affects the lungs, but almost any organ can be involved. Tuberculosis... read more or cancer. They may also consider HIV testing Diagnosis Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and is treated with antiretroviral medications. If untreated, it can cause... read more .

Treatment that helps control the symptoms of dry mouth consists of measures that

Drugs that increase saliva production include cevimeline and pilocarpine. The main side effect of cevimeline is nausea. The main side effects of pilocarpine include sweating, flushing, and excreting large volumes of diluted urine (polyuria).

Sipping sugarless fluids frequently and chewing gum that contains xylitol helps stimulate saliva flow. Using an over-the-counter saliva substitute containing carboxymethylcellulose, hydroxyethylcellulose, or glycerin may also help.

Petroleum jelly can be applied to the lips and under dentures to relieve drying, cracking, soreness, and trauma of the lining of the mouth. A cold-air humidifier may aid mouth breathers, who typically have their worst symptoms at night.

Meticulous oral hygiene is essential. People should brush (using a commercial or prescription fluoride toothpaste) and floss regularly (including just before bedtime) and use fluoride rinses or gels daily. Newer toothpastes with added calcium and phosphates also may help prevent cavities. People should see their dentist more often for preventive dental care and plaque removal. The most effective way to prevent cavities is to use custom-fitted mouth trays filled with prescription toothpaste for at-home fluoride application, especially at night. People may prefer to apply prescription fluoride toothpaste to the teeth without using a tray. In addition, a dentist can apply a sodium fluoride varnish 2 to 4 times per year.

People should avoid sugary or acidic foods and beverages and any irritating foods that are dry, spicy, or excessively hot or cold. People should especially avoid sugar near bedtime.