Xerostomia or dry mouth

Xerostomia (commonly called "dry mouth") is defined as the subjective feeling of dry mouth and is frequently associated with a reduction in saliva secretion. Xerostomia is a chronic and mostly irreversible condition induced as a side effect by hundreds of commonly used medications, mostly to treat chronic diseases (like hypertension, depression, urinary incontinence, etc.), by radiation therapy for head & neck cancer patients, by some auto-immune diseases (Sjögren’s syndrome is the most prominent) and by other conditions.

Dry mouth information sheet

Saliva and your oral health

Saliva is essential for maintenance of oral health. It provides lubrication to enable oral functions and protection to the teeth. The implications of reduced salivary secretion are well recognized such as, handicapped chewing, swallowing and speaking, bad breath, sleep disturbance and excessive tiredness. In addition, the teeth are exposed to high decay rate and thus to the need to be extracted, leading to high expenditures to restore the dentition.

Only recently the relationship of xerostomia with general quality of life has been systematically investigated. Xerostomia was found to be strongly associated with quality of life in a series of studies performed with old and young people. These findings suggest that the impact of dry mouth extends beyond the oral cavity and into people's day-to-day lives.

The late Israeli judge Shaul Aloni, wrote at a local newspaper “Half a year ago, a tumor has been discovered on my tongue, the intensive chemotherapy and radiation I have had, badly damaged my throat, but what kills me is not the cancer, but the inability to eat like a human being, which is the most horrible thing on earth. My mouth is dry, I have no saliva, and the pain in my throat is intolerable, it is a terrible period of time.”

Dry mouth study

A study of dry mouth (xerostomia) and quality of life in a representative sample of relatively young adults has found that the two are strongly associated, with clear differences between those that have xerostomia and those that not (Thomson WM et al, Acta Odontol Scand 2006;64:249-54). That study is part of a follow-up protocol performed routinely on about 1000 New-Zealanders which have been followed since birth. At an assessment at age 32, the participants were asked the question "How often does your mouth feel dry?". In response, 10% answered 'Frequently' or ‘Always'.

When asked specific questions concerning quality of life, almost half of those with xerostomia (but only about one in five of the remainder) reported one or more impacts occurring 'very often' or 'fairly often'. Data are presented in the next table, in which the numbers represent the percentage of persons responding "Yes" or "No".

Quality of life-related item Do you have xerostomia?
Yes No
Have you had trouble pronouncing any words? 5.5 1.1
Have you felt that your sense of taste has worsened? 12.1 0.8
Have you had painful aching in your mouth? 13.2 3.2
Have you found it uncomfortable to eat any foods? 15.4 4.6
Have you been self-conscious? 25.3 7.3
Have you felt tense? 14.3 2.8
Have you been a bit irritable with other people? 13.2 1.8
Have you had difficulty doing your usual jobs? 4.4 1.1
Have you felt that life in general was less satisfying? 11 1.8
Have you been totally unable to function? 5.5 0.7

Type of articles dry-mouth.org publishes

The impact factor of an academic journal is a measure reflecting the number of citations in articles published in other journals to publications of that journal. It is frequently used as a proxy for the relative importance of a journal within its field. We include in dry-mouth.org only articles published in journals with an impact factor of 1 or above.

What can you do if your mouth is dry?

There are several means that may help you in lessening dry mouth sensation (see also figure at the end of this leaflet). The most common are as follow:

Xerostomia patients leaflet

Stimulation of the salivary glands

  • The combination of chewing and taste, as provided by gums, lozenges or mints can be very effective in lessening mouth dryness. However, some products may be harmful (see below “Products to avoid”).
  • Medications that specifically increase salivary flow, such as pilocarpine and cevimeline, can be used but may cause significant adverse effects and are not available in all countries.
  • Acupuncture and electrostimulation of the salivary glands are novel treatment modalities that might alleviate the feeling of oral dryness.

Salivary substitutes (if stimulation fails or is not sufficient)

  • Drinking or sipping water remains by far the most used means to improve oral dryness.
  • Also, a number of salivary substitutes/artificial saliva agents are available as mouthwash, spray or gel.

Dental care

Lack of salivation carries an increased risk of dental caries (tooth decay). Effective preventive measures are:

  • Avoidance of food and beverages that are sweet, acidic or carbonated.
  • Meticulous oral hygiene.
  • Frequent dental check-ups and professional cleanings by dental hygienists (usually every 3-4 months).
  • Ask your dentist to advise you about other caries control measures. One of those may be daily use of non-acidic (neutral) toothpaste, mouthwash and gel rich in fluoride.

Products to avoid

Avoid using products containing alcohol, sugar, or strong flavourings as they may irritate your sensitive dry mouth. If you have teeth, do not use products that contain sugars, honey, maple syrups or sorghum as sweeteners. Also, do not use acidic products unless specially prepared for alleviating dry mouth.

How to put in practice a therapy for your dry mouth?

  • We suggest a step-wise approach (see list below). You may start with the first treatment modality, try it for about 2 weeks and, in case of no/little benefit, try the second and eventually the third. You may also use more than one treatment at the same time (e.g. gums and gel).
  • Chew and suck on (sugar-free) gums, lozenges or mints.
  • Use a saliva substitute gel during the night and when your daily activities are at a low level.
  • During the day, use water (possibly in a spray bottle) or a saliva substitute, mouthwash or spray. If this substitute is too sticky, dilute it with some water.
  • Consult your clinician and ask him/her whether you are likely to benefit from the use of stimulating drugs, electrostimulation or acupuncture.

Further advice

  • The use of room humidifiers, particularly at night, may lessen discomfort markedly. Keeping a glass of water besides your bed avoids the inconvenience of stepping to the kitchen or bathroom if you wake up with a dry mouth.
  • Contact your dentist, Oral Medicine specialist or Oral and Maxillofacial Surgeon if you develop oral redness, soreness and cracking of the corners of the mouth, as these may be features of candidosis (thrush), a common oral infection in individuals with reduced salivation.
What can you do if your mouth is drty?