Dry Mouth

Dry mouth (Xerostomia) is one of the very serious oral problems that impair the quality of life of patients. The main cause of it is the deterioration of the fluid balance in the mouth with the reduction of saliva. Saliva is a secretion with many functions. First of all, saliva is actively involved in taste, and taste disturbances occur when saliva is reduced. Since saliva contains an enzyme such as alpha-amylase that initiates digestion, it plays an important role in the breakdown and digestion of food. In addition, saliva washes our teeth, removing food residues.

One of the most important functions of saliva is to protect the oral surface, teeth, and gums against microbes thanks to some of the substances it contains. In this way, saliva prevents the formation of plaque on the tooth, which acts as a home for bacteria and causes tooth decay. Therefore, reduced saliva increases dental caries, gum diseases, and intraoral infections (eg, oral thrush). A dry mouth caused by the reduction of saliva can also cause a recession in the gums. Finally, one of the reasons for oral malodor is mouth dryness due to lack of saliva.

Dry Mouth Symptoms and Signs

To understand whether someone’s mouth is drying, it is necessary to tilt his head back and look at the deepest or deepest point of the palate. If we see dryness there, we can conclude that the person has a saliva shortage. Or we can ask that person to make this certain.

Xerostomia generally manifests itself in the form of dry lips and tongue, cracking, taste disturbance, stickiness in the mouth, voice disorders, and difficulties in speaking, chewing, and swallowing. Due to the dryness, the person cannot maintain complete oral hygiene. There may be increases in dental caries, gum diseases, and intraoral infections.

Dry Mouth Causes

A dry mouth can give many clues not only about oral health but also about our general health. Because it can be caused by local causes as well as systemic causes that concern the whole body.

The most common systemic causes of dry mouth are primarily diabetes (the most common cause), and diseases such as Parkinson’s and Sjögren’s. In addition, old age and the side effects of some medications may cause a decrease in saliva. Due to oncological diseases, radiotherapy and chemotherapy treatments that the patient receives can also reduce saliva and cause mouth dryness.

Dry mouth is also seen in cases where local causes such as adenoid enlargement and nasal congestion force the person to breathe through the mouth. In addition, some problems related to the neck and throat (eg, tumors) can cause it. Since the nerves stimulate the secretion of saliva from the salivary glands, saliva shortage may occur in the patient if there is a problem in the nerves associated with these glands.

The Most Common Cause: Systemic Diseases

Diabetes: The Most Common Cause

When you think of dry mouth, diabetes comes to mind first, because it is the most common cause. Dry mouth is one of the important symptoms of diabetes. In diabetes, the amount of saliva is reduced and there is a rapidly progressive dry mouth. Diabetes also manifests itself in the form of frequent urination (especially at night) and the desire to drink a lot of water. General fluid loss in the body with frequent urination is one of the factors that predispose to mouth dryness.

Diabetes also causes taste disorders along with mouth dryness. Patients experience different tastes in the mouth (eg, metal taste) or experience loss of taste. Therefore, if the patient has more complaints of dry mouth and taste disturbance, the patient should have a blood sugar test.

Sjögren’s Syndrome

Dry mouth can also occur in the course of Sjögren’s syndrome, which is one of the systemic diseases. In Sjögren’s syndrome, salivary gland cells are destroyed due to the deterioration of the immune system. Therefore, the amount of saliva decreases, and a severe dry mouth occurs. Since Sjögren’s syndrome manifests itself with the reduction of other secretions in the body, the patient also has a decrease in tears and dry eyes. But Sjögren’s syndrome is not a common cause of mouth dryness.

Drugs

One of the important factors that cause dry mouth is medications. During the use of some medications, mouth dryness may occur in the patient. In general, it is known that nearly 400 drugs cause dry mouth. In particular, some drugs, those against colds, allergies, cholesterol, blood pressure, psychiatric drugs, and chemotherapy can cause it.

Other Causes

In addition, eating too much fat, alcohol intake, tobacco use, drinking little water, vitamin deficiencies, nutritional disorders, hectic, stressful, and fast life, short-term or temporary dry mouth may cause. But in long-term mouth dryness, the reason is mostly underlying systemic diseases.

Home Remedies

There are some useful home remedies for dry mouth in our daily lives that can relieve or at least alleviate it and its consequences. For example, in the case of mouth dryness, we need to do a good and regular cleaning to protect the teeth and gums. We should take care of brushing our teeth after each meal and avoid sugary foods and drinks between meals. Since there may be a problem with our teeth due to dryness, we need to brush our teeth regularly with toothpaste containing fluoride and lactoperoxidase. Also, we can use special dry mouth mouthwash (oral rinse with the American Dental Association (ADA) seal such as; Biotene Dry Mouth Oral Rinse, or as a different choice: TheraBreath Dry Mouth Oral Rinse, etc.) as a solution. Gargles prepared with saltwater, bicarbonate, glycerol, and lemon can also relieve dry mouth.

Using artificial saliva

We can use artificial saliva to reduce dry mouth. These preparations consist of substances that can mimic the moisturizing and lubricating properties of saliva. However, although this artificial saliva replaces a certain amount of saliva, they do not increase saliva. So replacing saliva and increasing saliva are different things.

Chewing gums

There are chewing gums that do not contain a certain amount of xylitol, but 100% Xylitol and contain artificial sweeteners (eg, PUR 100% Xylitol Gum, XyloBurst 100% Xylitol Gum, B-Fresh 100% Xylitol Gum, etc.). Consuming these gums can naturally speed up the saliva flow rate. Because these types of sugar-free gums and lozenges can stimulate saliva secretion. But we should not forget that if we are going to chew gum, it must be sugar-free gum.

Daily fluid intake

In case of mouth dryness, attention should be paid to adequate fluid intake. We can also add milk to our liquid intake. However, drinking plenty of water does not increase saliva. For example, some people walk around with a bottle in their hands and drink water frequently. They can drink it, it is healthy, but one should not expect that it will increase salivation. No matter how much water we drink, this water will eventually turn into urine, not saliva. Drinking water is only for a certain period and rate to relieve dry mouth. In this respect, sipping water throughout the day can only be beneficial.

Limiting alcohol, caffeine, and nicotine

The patient with the complaint of dry mouth should avoid alcohol and caffeine as much as possible. Because alcohol can cause it. Apart from these, those who use cigarettes, pipes, and other tobacco products frequently encounter dry mouth. Even when choosing oral care products, it is necessary to choose alcohol-free oral rinses with the American Dental Association (ADA) seal such as CloSYS Sensitive Gentle Mint, CloSYS Ultra Sensitive Unflavored, etc., or special alcohol-free plus zinc-containing products (eg, TheraBreath Plus Fresh Breath, Tom’s of Maine Natural Wicked Fresh, etc.). 

Changing lifestyle

To relieve dry mouth by increasing saliva, the patient should change his lifestyle. Under normal conditions, unscheduled and hectic life causes mouth dryness. It is very difficult to get rid of it without getting rid of this lifestyle. If the patient can achieve a calm, programmed, and non-hectic lifestyle, the saliva will increase and reach the previous sufficient volume.

Dry Mouth Treatment

Saliva is not a simple liquid that we can replace immediately in case of deficiency. It contains many minerals, enzymes, and digesters. The start of digestion in the mouth shows how important our saliva is.

Treatment of dry mouth should be aimed at finding and eliminating the underlying cause. For example, ongoing treatment for another disease (such as chemotherapy, or radiation therapy) may be the cause of saliva shortage. Normally, it will end with the disappearance of the underlying cause or the completion of that treatment.

Dry mouth due to systemic diseases

If a systemic disease causes dry mouth, first of all, this disease should be treated. Diabetes and Parkinson’s patients feel their mouths dry, especially when they wake up in the morning. These patients will benefit greatly if they pay attention to some things such as the diet, regular drinking of water, and the recommended medications.

Dry mouth due to radiotherapy and chemotherapy

Patients receiving treatment for oncological diseases should use drugs that increase saliva formation. In particular, patients who receive radiation therapy have serious problems in saliva production, as radiotherapy damages the salivary glands. These patients cannot get rid of xerostomia by just drinking water and eating regularly. Patients should use saliva enhancers or saliva substitutes (artificial saliva, mouth gels, mouthwashes) to keep their mouths moist. Patients should use these substances before eating and eat after that.

Drug-induced dry mouth

If the drug used by the patient (usually a side effect of the drug) causes dry mouth, temporarily suppressing or eliminating the results of that drug is also a solution. In these cases, the patient may use artificial saliva, mouthwash, or gargle as a solution. When the medication that causes xerostomia ends, the problem will resolve itself. If the patient has to use a drug that causes mouth dryness continuously (for example, due to chronic disease), he will continue with the methods recommended by the doctor or dentist to relieve it.

Dry mouth due to localized diseases

If the patient has problems with the neck and throat, inability to breathe through the nose, and dry mouth caused by an open mouth, the doctor or dentist may take some steps to eliminate the cause. In these cases, the doctor or dentist can also make specific recommendations to the patient that can alleviate the condition. In addition, the doctor or dentist can add mouthwashes that reduce mouth dryness, regular drinking of water, chewing gums containing xylitol, and other common methods.

Using several drugs

Some medications stimulate saliva secretion. Doctors can recommend these drugs to patients when necessary. Apart from these, some medications induce parasympathetic stimulation for calm living. However, these drugs are the last solution to be applied because they slow down the heart.

Conclusion

The treatment of xerostomia aims to keep the patient’s mouth wet and moist, maintain its pH, and prevent tooth decay with the substances and drugs to be used. They also mechanically facilitate eating. However, the ultimate goal of the treatment is to permanently maintain the natural environment of the mouth in the patient. In this respect, if there is an underlying cause, condition, or disease, its treatment is more important first.