Causes

Dry mouth occurs when the salivary glands that make saliva don’t work properly.  Many over-the-counter and prescription medicines, as well as diseases such as diabetes, Parkinson’s disease and Sjogren’s syndrome, can affect the salivary glands.  Other causes of dry mouth include certain cancer treatments and damage to the glands’ nerve system.  It’s important to see your dentist or physician to find out why your mouth is dry.

Treatment

Depending on the cause of your dry mouth, your health care provider can recommend appropriate treatment. There are also self-care steps you can take to help ease dry mouth, such as drinking plenty of water, chewing sugarless gum, and avoiding tobacco and alcohol.  Good oral care at home and regular dental check-ups will help keep your mouth healthy.

Sjogren’s syndrome is an autoimmune disease If you have an autoimmune disease, your immune system, which is supposed to fight disease, mistakenly attacks parts of your own body. In Sjogren’s syndrome, your immune system attacks the glands that make tears and saliva. It may also affect your joints, lungs, kidneys, blood vessels, digestive organs and nerves. The main symptoms are:

• Dry eyes
• dry mouth

What Causes Sjögren’s Syndrome?

Sjögren’s syndrome is an autoimmune disease. The immune system is supposed to fight disease by killing off harmful viruses and bacteria. But with autoimmune diseases, your immune system attacks parts of your own body by mistake.

In Sjögren’s syndrome, your immune system attacks the glands that make tears and saliva (spit). The damage keeps these glands from working right and causes dry eyes and dry mouth.

Doctors don’t know the exact cause of Sjögren’s syndrome. They think it may be caused by a combination of two things:

• Genes
• Exposure to something like a virus or bacteria.
• What Are the Symptoms of Sjögren’s Syndrome?

The main symptoms are:

• Dry eyes
• Dry mouth.

Sjögren’s syndrome also can affect other parts of the body, including the skin, joints, lungs, kidneys, blood vessels, digestive organs, and nerves. Symptoms can include:

• Dry skin
• Skin rashes
• Chronic dry cough
• Thyroid problems
• Joint and muscle pain
• Vaginal dryness
• Numbness and tingling in the arms and legs.

Sjögren’s can also make you very tired.

How Is Sjögren’s Syndrome Diagnosed?

Doctors use a few ways to diagnose Sjögren’s:

• Medical history
• Physical exam
• Certain eye and mouth tests
• Blood tests.

Doctors may also use:

• A urine test
• A chest x ray.
• How Is Sjögren’s Syndrome Treated?

Treatment differs for each person. It depends on what parts of the body are affected. Treatment will focus on getting rid of symptoms. Treatment may include:

• Medicines for joint or muscle pain (such as aspirin and ibuprofen)
• Medicines that help you make more saliva
• Medicines that suppress inflammation (such as corticosteroids)
• Medicines that suppress the immune system.

Treatment for dry eyes may include:

• Artificial tears that come in different thicknesses. You may have to try a few to find the right one.
• Eye ointments. These are thicker than artificial tears. They protect the eyes and keep them wet for several hours. They can blur your vision, so you may want to use them while you sleep.
• Medicines to reduce inflammation in the eye.
• A chemical that wets the surface of the eye and keeps the natural tears from drying out so fast. It comes in a small pellet that you put in your lower eyelid. When you add eye drops, the pellet melts. This forms a film over your own tears and traps the moisture.
• Surgery to shut the tear ducts that drain tears from the eye.

Treatment for dry mouth may include:

• Chewing gum or sucking on hard candy helps your glands make more saliva. However, gum and candymust be sugar-free.
• Sipping water or a sugar-free drink often to wet your mouth.
• Using oil or petroleum-based lip balm or lipstick to help dry, cracked lips feel better.
• Using a saliva substitute prescribed by a doctor to make the mouth feel wet.
• Using medicine to help your mouth make more saliva.

People with dry mouth can easily get mouth infections. Tell your doctor if you have white patches or red, burning areas in your mouth.

Medicines and Dryness

Some medicines can cause eye and mouth dryness. If you are taking one of the drugs listed below, ask your doctor whether you should stop.

Drugs that can cause dryness include:

• Those used for allergies and colds (antihistamines and decongestants)
• Those used to lower fluids (diuretics)
• Some used to treat diarrhea
• Some used to treat blood pressure
• Some antipsychotic medicines
• Tranquilizers
• Antidepressants.
• What Research Is Being Done on Sjögren’s Syndrome?

Studies are being done on:

• Genes and gene therapy
• Bacteria and viruses
• The immune system
• Hormones
• Predicting who may have lung problems
• Treating other skin problems
• Medicines that help the glands make moisture
• Medicines to help the immune system and reduce swelling.

Patients with a persistently dry mouth may develop a burning or scalded sensation and have poor oral hygiene. They are prone to increased dental caries, periodontal disease, intolerance of dentures, and oral infections, particularly candidiasis. Where possible, treatment is directed at the underlying cause of dry mouth. If this is not possible, or is only partially successful, symptomatic treatment is used.

Treating the underlying cause
Drugs are a common cause of dry mouth. Reduce the dose or change the drug if possible. Morphine is a common, but often overlooked, cause of dry mouth. Other drugs that cause dry mouth include tricyclic antidepressants, antihistamines, antimuscarinic drugs, antiepileptic drugs, antipsychotics, betablockers, and diuretics.
Dehydration should be treated.
Simple measures will often relieve symptoms of dry mouth, even if rehydration is not undertaken.
Anxiety can also cause dry mouth.
Sjögren’s syndrome – check anti-nuclear antibody titre.

General measures

Simple measures should be used by all patients. Dry mouth may be relieved in many patients by:

Frequent sips of cool drinks.
Sucking pieces of ice.
Sucking sugar-free fruit pastilles.
Eating partly frozen melon or pineapple chunks.
Sugar-free chewing gum stimulates salivation in patients with residual salivary function.
Petroleum jelly can be applied to the lips to prevent drying and cracking.

Artificial saliva offers little advantage compared with simple measures for most patients. The few available studies are of poor quality, but suggest that many patients find no additional benefit with carmellose-based preparations compared with frequent tea, coffee, milk, or fruit juice.1 In addition, some patients find carmellose-based products feel sticky.
The duration of action of mucin products is only 10 to 15 minutes.
Long-term use of acidic products may demineralise tooth enamel. Glandosane® spray, Salivix® pastilles, and SST® tablets are acidic products.
Sugar-free chewing gum is as effective as artificial salivas.2
Consider using an artificial saliva containing mucin or lactoperoxidase when simple measures have been tried, but symptoms remain troublesome. The pH of some artificial saliva products may be inappropriate.

Luborant® is licensed for any condition giving rise to a dry mouth.
Biotene Oralbalance® BioXtra®, Glandosane®, Saliva Orthana®, and Saliveze®, have Advisory Committee on Borderline Substances (ACBS) approval for dry mouth associated only with radiotherapy or Sjögren’s syndrome.
Salivix® pastilles, which act locally as salivary stimulants, are also available and have similar ACBS approval.
SST® tablets may be prescribed for dry mouth in patients with salivary gland impairment and patent salivary ducts.

Pilocarpine tablets
These are licensed for the treatment of xerostomia following:

Irradiation for head and neck cancer
Dry mouth and dry eyes (xerophthalmia) in Sjögren’s syndrome
It can be considered for difficult cases.

Most patients with drug-induced dry mouth usually respond to treatment after the first dose.3
Only about 50% of patients with radiotherapy-induced dry mouth respond to treatment, and it may take up to 3 months before a response is seen.3
Pilocarpine 5 mg three times a day is more effective than artificial saliva, but also has more adverse effects, e.g. sweating, dizziness, rhinitis, urinary frequency, and blurred vision.
Acupuncture may be a useful alternative to pilocarpine in resistant cases.4
They are effective only in patients who have some residual salivary gland function. If there is no response they should be discontinued.
There is a risk of increased urethral smooth muscle tone and renal colic.
Adequate fluid intake should be maintained to avoid dehydration associated with excessive sweating.
Patients should be counselled that blurred vision or dizziness may affect performance of skilled tasks, e.g. driving, particularly at night or in reduced lighting.

This was a prospective, randomized, open, crossover study comparing a mucin-based artificial saliva (Saliva Orthana) with a low-tack, sugar-free chewing gum (Freedent) in the management of xerostomia in patients with advanced cancer. The conclusions of this study were that both Saliva Orthana and Freedent are effective in the management of xerostomia in patients with advanced cancer, that both Saliva Orthana and Freedent cause some side-effects in this group of patients, and that patients with cancer think that chewing gum is an acceptable treatment. Sixty-nine per cent of the patients preferred the chewing gum to the artificial saliva. Furthermore, the chewing gum scored better than the artificial saliva on every measure of efficacy. However, none of these results reached statistical significance.

In this investigation, the subjective impressions of patients, suffering from severe xerostomia, have been recorded after symptomatic treatment with different CMC- and mucin-containing artificial saliva over 3 years. A total number of 137 patients divided into 3 groups participated. Group I (40 patients) used CMC-containing artificial saliva, group II (61 patients) alternately used CMC- and mucin-containing artificial saliva and group III (36 patients) used mucin-containing artificial saliva. From this study it is concluded that artificial saliva containing mucins proved to be of benefit to patients suffering from xerostomia.

This was a crossover study comparing a mucin-based artificial saliva (Saliva Orthana) and pilocarpine hydrochloride (Salagen) in the management of xerostomia in patients with advanced cancer. The pilocarpine was found to be more effective than the artificial saliva in terms of mean change in visual analogue scale scores for xerostomia (P = 0.003). Furthermore, more patients reported that it had helped their xerostomia, and more patients wanted to continue with it after the study. However, the pilocarpine was found to be associated with more side-effects than the artificial saliva (P < 0.001). These side-effects were usually reported as being mild. Of the patients who used both treatments, 50% preferred the artificial saliva, and 50% preferred the pilocarpine. The commonest reason for preferring the artificial saliva was the fact that it was a spray, rather than a tablet.

There may be a way to aid dry mouth condition.

A new battery-powered mouthguard was created to fix this problem. The mouthguard fits over the lower arch of the teeth and enables the production of saliva thanks to little electric shocks. This device is necessary because dry mouth impacts 20 percent of people older than 50.

This device could be extremely helpful because of the importance of saliva in digestion and fighting against bacteria. A healthy person can generate three pints of saliva per day but there are many people that don’t produce enough. The result is the condition of dry mouth, known as xerostomia. The condition usually stems from some kind of medication or cancer treatment.

This new mouthguard is custom designed for each person and triggers saliva production by way of electric shocks. Each patient controls the device and can be worn for up to 10 minutes every hour.

The device can be beneficial for people who developed dry mouth from Parkinson’s Disease and Sjogren’s Syndrome. More tests are on the way.

Scientists have also created mint disks with Xylitol in them, which are thought to aid dry mouth. The disks are applied at night. They melt while the person is asleep and studies from the University of Washington indicate a reduced impact of dry mouth symptoms with one week.