Dry mouth

Definition

Dry mouth occurs when you don't make enough saliva. This causes your mouth to feel dry and uncomfortable. Dry mouth that is ongoing may be a sign of illness, and can lead to problems with your mouth and teeth.

Alternative Names

Xerostomia; Dry mouth syndrome; Cotton mouth syndrome; Cotton mouth; Hyposalivation; Oral dryness

Considerations

Saliva helps you break down and swallow foods and protects teeth from decay. A lack of saliva may cause a sticky, dry feeling in your mouth and throat. Your saliva may become thick or stringy. Other symptoms may include:

• Cracked lips
• Dry, rough, or raw tongue
• Loss of taste
• Sore throat
• Burning or tingling sensation in the mouth
• Feeling thirsty
• Difficulty speaking
• Difficulty chewing and swallowing

Too little saliva in your mouth allows acid-producing bacteria to increase. This can lead to:

• Bad breath
• Increase in dental cavities and gum disease
• Increased risk for yeast infection (thrush)
• Mouth sores or infections

Causes

Dry mouth occurs when salivary glands do not produce enough saliva to keep your mouth wet or they stop making it altogether.

Common causes of dry mouth include:

• Many medicines, both prescription and over-the-counter, such as antihistamines, decongestants, and medicines for conditions including high blood pressure, anxiety, depression, pain, heart disease, asthma or other respiratory conditions, and epilepsy
• Dehydration
• Radiation therapy to the head and neck that can damage the salivary glands
• Chemotherapy that can affect the production of saliva
• Injury to the nerves involved in the production of saliva
• Health problems such as Sjögren syndrome, diabetes, HIV/AIDS, Parkinson disease, cystic fibrosis, or Alzheimer disease
• Removal of salivary glands due to an infection or tumor
• Tobacco use
• Drinking alcohol
• Street drug use, such as smoking marijuana or using methamphetamine (meth)

You can also get dry mouth if you feel stressed or anxious, breathe through your mouth, or become dehydrated.

Dry mouth is common in older adults. But aging itself does not cause dry mouth. Older adults tend to have more health conditions and take more medicines, which increases the risk of dry mouth.

Home Care

Try these tips to soothe dry mouth symptoms:

• Drink plenty of water or fluids to stay hydrated.
• Suck on ice chips, frozen grapes, or sugar-free frozen fruit pops to help keep your mouth moist.
• Chew sugar-free gum or hard candy to stimulate saliva flow.
• Try to breathe through your nose and not your mouth.
• Use a humidifier at night when sleeping.
• Try over-the-counter artificial saliva or mouth sprays or moisturizers.
• Use oral rinses made for dry mouth to help moisten your mouth and maintain oral hygiene.

Making these changes in your diet may help:

• Eat soft, easy-to-chew food.
• Include cool and bland foods. Avoid hot, spicy and acidic foods.
• Eat foods with a high liquid content, such as those with gravy, broth, or a sauce.
• Drink liquids with your meals.
• Dunk your bread or other hard or crunchy food in a liquid before swallowing.
• Cut your food into small pieces to make it easier to chew.
• Eat small meals and eat more often.

Certain things can make dry mouth worse, so it's best to avoid:

• Sugary drinks
• Caffeine from coffee, tea, and soft drinks
• Alcohol and alcohol-based mouth washes
• Acidic foods such as orange or grapefruit juice
• Dry, rough foods that may irritate your tongue or mouth
• Tobacco and tobacco products

To take care of your oral health:

• Floss at least once per day. It is best to floss before brushing.
• Use a fluoride toothpaste and brush your teeth with a soft-bristled toothbrush. This helps prevent damage to tooth enamel and gums.
• Brush after every meal.
• Schedule regular checkups with your dentist. Talk with your dentist about how often to have checkups.

When to Contact a Medical Professional

Contact your health care provider if:

• You have dry mouth that does not go away
• You have trouble swallowing
• You have a burning sensation in your mouth
• You have white patches in your mouth

What to Expect at Your Office Visit

Proper treatment involves finding out the cause of dry mouth.

Your provider will:

• Review your medical history
• Examine your symptoms
• Take a look at the medicines you are taking

Your provider may order:

• Blood tests
• Imaging scans of your salivary gland
• Salivary flow collection test to measure saliva production in your mouth
• Other tests as needed to diagnose the cause

If your medicine is the cause, your provider may change the type or medicine or the dose. Your provider may also prescribe:

• Medicines that promote the secretion of saliva
• Saliva substitutes that replace natural saliva in your mouth

References

Elluru RG. Physiology of the salivary glands. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 81.

National Institute of Dental and Craniofacial Research website. Dry mouth. www.nidcr.nih.gov/health-info/dry-mouth. Updated September, 2022. Accessed June 8, 2023.

Pham KL, Mirowski GW. Oral diseases and oral manifestations of gastrointestinal and liver diseases. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 24.

Popovtzer A, Eisbruch A. Radiotherapy for head and neck cancer: radiation physics, radiobiology, and clinical principles. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 75.