Dry mouth
Saliva looks like a trifle right up to the day there stops being enough of it. About a litre and a half is produced every day, and it does more than keep the…
On this page
- Where to start: go through the medicine cupboard
- Dryness with a thirst that will not settle
- It dries out at night: mouth breathing
- A dry mouth and dry eyes at the same time
- When the glands themselves have been damaged
- Why the dentist here is not a matter of appearances
- What helps from day to day
- What must not be put down to dryness
- Online consultation
Medicines commonly prescribed for Dry mouth
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: TABLET, 600 mgActive substance: thioctic acidManufacturer: Woerwag Pharma Gmbh & Co. KgPrescription required
Saliva looks like a trifle right up to the day there stops being enough of it. About a litre and a half is produced every day, and it does more than keep the mouth wet: it washes away food debris, neutralises acid, holds bacteria and yeast in check and makes chewing, swallowing and tasting possible. When saliva runs short, several things fall apart at once. A dry mouth is rarely a sign of anything frightening, but it almost never happens for no reason — and very often the reason is printed on the box of a medicine somebody takes every morning.
Where to start: go through the medicine cupboard
This is the commonest cause of a dry mouth and at the same time the one most easily put right. The list of drugs with that side effect is enormous; the ones that come up most often are:
- antihistamines for allergy and medicines for travel sickness;
- antidepressants, especially the older groups, antipsychotics, and medicines for anxiety and for sleep;
- diuretics and some blood pressure medicines;
- medicines for an overactive bladder and for abdominal spasm;
- strong painkillers of the opioid group;
- inhalers for asthma and chronic lung disease, particularly if the mouth is not rinsed afterwards;
- decongestants for a blocked nose;
- medicines for Parkinson's disease, muscle relaxants and some cancer treatments.
Older people deserve a separate word. What usually matters is not age in itself but the number of medicines: five or seven drugs, each drying the mouth slightly, add up to a marked dryness between them. Do not stop anything prescribed on your own initiative. Gather up everything you take, over-the-counter products and supplements included, and show the whole lot to your doctor: it is often possible to swap a drug within the same group, move the time of the dose, or drop something that stopped being necessary long ago.
Dryness with a thirst that will not settle
There is one combination worth knowing by heart: a dry mouth, constant thirst, getting up at night to pass water, weight coming off without trying, and mounting tiredness. That is how diabetes announces itself, and it is the commonest internal illness among the causes of a dry mouth.
The mechanism is straightforward: excess sugar leaves in the urine and drags water with it, the body loses fluid and there is less saliva. The person drinks more, passes water more often, and the circle closes. It is checked with one inexpensive blood test for glucose, and it is worth doing before itching, slow-healing sores and blurred vision join in.
Ordinary dehydration works the same way, only it reverses within hours: heat, exercise, vomiting and diarrhoea, a high temperature, too little drinking in an older person. In the elderly the sensation of thirst is blunted, and a dry tongue is often the first outward sign that fluid is short.
It dries out at night: mouth breathing
If the mouth is dry precisely on waking and everything is back to normal by mid-morning, look for the cause in the nose. Breathing through the mouth overnight dries the lining with a stream of air even though the salivary glands themselves are working perfectly well.
Nasal breathing is obstructed by a deviated septum, chronic rhinitis and allergy, polyps, and in children by enlarged adenoids. Snoring and pauses in breathing during sleep are a chapter of their own: if alongside the dry mouth there is loud snoring, pauses that other people have noticed, waking unrefreshed and a morning headache, that is reason enough to be assessed for sleep apnoea. Winter heating dries the air too, as do positive-pressure breathing machines when the humidifier on them is not set up properly.
Until the cause is dealt with, a humidifier in the bedroom, a saline nasal rinse at night and a glass of water by the bed all help. But the right answer is to sort out the nose.
A dry mouth and dry eyes at the same time
These two complaints usually live apart: one takes you to the dentist and the other to the eye clinic, and nobody adds them together. Added together they mean something quite specific — Sjögren's syndrome, a disease in which the immune system destroys the glands that make saliva and tears.
It is worth suspecting when several features coincide:
- the dry mouth has lasted months, dry bread will not go down without water, and you wake at night for a drink;
- at the same time the eyes sting and feel gritty and, oddly enough, sometimes stream;
- joint pain and morning stiffness, persistent fatigue;
- the salivary glands in front of the ears or under the jaw swell from time to time;
- the teeth have started to crumble and decay unusually fast.
This belongs with a rheumatologist: blood tests for particular antibodies and an assessment of how the glands are working are needed. Mention both kinds of dryness in the same breath — it is the pairing, not either complaint on its own, that leads to the diagnosis. The eye half of that pair is set out in detail on the neighbouring page, «Dry eyes».
When the glands themselves have been damaged
Salivary glands can be injured directly, and the dryness that follows tends to be lasting.
- Radiotherapy to the head and neck. The glands sit inside the treated field, and dryness develops in almost everyone treated for tumours in that region. Some of the function returns over months; some does not. This should be discussed with the doctor before treatment starts: modern techniques can spare the glands, and a full dental overhaul is arranged beforehand.
- Chemotherapy. The dryness is more often temporary, but inflammation of the lining readily joins in while it lasts.
- A stone in the gland's duct. It gives itself away by a characteristic pattern: the gland under the jaw or in front of the ear swells and hurts precisely at mealtimes, especially at the sight of something sour, and subsides an hour or two later.
- Infections. Mumps swells the glands painfully and with a temperature. Bacterial inflammation of a gland — redness, a firm painful swelling, pus coming from the duct, fever — needs to be seen the same day.
- The reaction that can follow a bone marrow transplant, and some diseases affecting gland tissue.
Why the dentist here is not a matter of appearances
This is the part most often missed. Saliva is the tooth's main natural defence: it sweeps away plaque, neutralises acid after eating and delivers minerals to the enamel. Without it decay advances several times faster than usual, and it does so not where people expect but at the necks of the teeth right by the gum and on the roots. Somebody whose teeth have been sound for decades can watch half a mouth fall apart within eighteen months of dryness. Yeast behaves the same way: white patches, a burning tongue, cracks and redness at the corners of the mouth.
So when the dryness persists, dental care stops being a matter of taste:
- brushing twice a day with fluoride toothpaste, and floss or interdental brushes daily;
- extra fluoride products — gel, varnish or rinse — as advised by the dentist;
- an alcohol-free mouthwash: the alcohol kind dries things further;
- check-ups more often than usual, and say it in plain words: «my mouth is dry»;
- giving up the habit of sipping sweet tea, juice or fizzy drinks all day long — with a dry mouth that is the fastest route to losing teeth;
- taking removable dentures out at night, cleaning them and storing them properly.
What helps from day to day
- Water in small sips through the day and a glass by the bed; at meals, wash down every mouthful.
- Sugar-free chewing gum and sugar-free sweets: the chewing and the slight sharpness start your own saliva flowing, and that beats any substitute. If you still have your own teeth, choose products with no acid in them.
- Ice cubes and frozen fruit, sucked slowly.
- Saliva substitutes from the pharmacy: gels, sprays and lozenges. A gel suits the night better and a spray the daytime. They are chosen by trial.
- Soft, moist food with sauces; drop dry, salty, spicy and very sweet things for a while.
- Less alcohol, coffee and strong tea, and stopping smoking; no alcohol-based mouthwashes.
- Lip balm if the lips crack, and a humidifier in the bedroom.
- If the dryness comes from a blocked nose, treat the nose rather than sucking sweets indefinitely.
What must not be put down to dryness
See a doctor without delay if, alongside the dryness, any of this appears:
- an ulcer, sore or crack in the mouth that has not healed in more than three weeks;
- a white or red patch on the lining, on the tongue or under it, that does not rub off;
- a lump, nodule or swelling in the mouth, in the neck or over a salivary gland, particularly a hard and painless one;
- pain or difficulty on swallowing, a feeling of something stuck, a change in the voice, teeth loosening for no clear reason;
- numbness of the lip, tongue or chin.
These signs matter especially in people who smoke and drink heavily: their risk of mouth cancer is higher, and dryness explains away and masks an early complaint all too easily. Be seen the same day if a gland turns hot, red and sharply painful with pus from the duct and a fever, and also if the mouth has dried out in the course of vomiting and diarrhoea and there is dizziness, confusion or very dark urine.
Not urgently but without fail, see a doctor when the dryness interferes with eating and speaking, lasts for weeks, spoils the taste, brings white coatings, cracked lip corners or soreness under a denture, or when you suspect one of your medicines is behind it.
Online consultation
A remote appointment is surprisingly productive here. The doctor will go through your full list of medicines with you and pick out the ones capable of drying the mouth — the single most rewarding thing that can be done about this problem. They will ask about thirst, night-time trips to the lavatory and weight, so that diabetes is not missed, and tell you which test to have. They will establish whether the mouth is dry round the clock or only towards morning, and whether the nose needs attention. They will check for the link with dry eyes and joints. They will explain which saliva substitutes are worth trying and how to organise dental care so that you do not lose teeth within a year. And they will go separately through the signs that call for an examination in person.
This material is for information only and does not replace medical advice.
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