There is a question I have heard many times in the pharmacy:
“Why is my mouth always so dry?”
Usually, the person has already tried drinking more water.
Sometimes they are carrying a bottle around with them all day.
They take a sip.
The dryness improves.
Then ten minutes later, it is back again.
A dry mouth is one of those symptoms that is easy to dismiss. People often put it down to getting older, not drinking enough or simply having a dry throat.
But persistent dry mouth is worth paying a little more attention to.
The medical term is xerostomia, and it basically means there isn’t enough saliva to keep the mouth properly moist.
And saliva is rather more important than most of us realise.
Saliva isn’t just water
We tend to think of saliva as something that helps us swallow our food.
It does much more than that.
Saliva moistens food, helps with chewing and swallowing, helps keep the mouth clean and contains minerals that help protect the teeth.
It also helps control bacteria and other organisms in the mouth.
So when saliva production falls, the consequences can go beyond simply feeling thirsty.
People can find it harder to chew or swallow.
Food can taste different.
The tongue may feel dry, sticky or sore.
The lips can crack.
Some people develop bad breath.
And because saliva normally helps protect the teeth, persistent dry mouth can increase the risk of tooth decay and infections in the mouth. (NIDCR)
That is why I don’t regard persistent dry mouth as just an irritation.
One of the first things I check is medication
This is probably the most important pharmacy point.
There are a lot of medicines that can cause dry mouth.
Some medicines for depression, blood pressure and bladder problems are examples, but there are many others.
And it doesn’t necessarily have to be a newly started medicine.
Someone may have been taking the same medicines for years and suddenly notice the problem.
Sometimes it is because another medicine has been added.
Sometimes several medicines each contribute a little to the problem.
This is particularly relevant in older people who may be taking several medicines at the same time. (NIDCR)
So when somebody tells me they have developed a persistent dry mouth, one of the first things I want to know is:
“What medicines are you taking?”
That is one reason your pharmacist can be useful.
We can go through the medicines and check whether dry mouth is a recognised side effect.
But there is an important warning here.
Don’t stop a prescribed medicine yourself just because you think it is causing the problem.
There may be a perfectly good reason you need it, and there may be another way of managing the side effect.
The NHS specifically advises getting medical advice rather than stopping a prescribed medicine yourself. (nhs.uk)
It isn’t always dehydration
Of course, dehydration can cause a dry mouth.
If you’ve been sweating heavily, have been unwell, haven’t been drinking enough or have lost fluid through vomiting or diarrhoea, your mouth can certainly become dry. (nhs.uk)
But dry mouth does not automatically mean you are dehydrated.
One common example is someone who wakes up every morning with an incredibly dry mouth but feels fine during the day.
Sometimes the explanation is much simpler.
They are sleeping with their mouth open.
A blocked nose, nasal congestion or simply breathing through your mouth at night can all contribute to dry mouth. (nhs.uk)
If you snore heavily or regularly wake up with a mouth that feels like sandpaper, it is worth thinking about how you are breathing while asleep.
So what can you do?
The first thing is fairly obvious:
Drink regularly.
Small, frequent sips of water can be more useful than waiting until your mouth becomes extremely dry.
Chewing sugar-free gum can also help because it stimulates saliva production.
Sugar-free sweets or lozenges can be useful for the same reason. (NIDCR)
And this is one situation where I would specifically say sugar-free.
If your mouth is dry, the last thing you want to be doing throughout the day is repeatedly exposing your teeth to sugar.
That is because saliva normally helps protect the teeth against the processes that lead to decay. (NIDCR)
Look after your teeth
This part is often overlooked.
Someone has a dry mouth, so they concentrate on finding something to make it feel better.
But the longer-term issue is protecting the teeth.
Continue brushing twice a day with fluoride toothpaste and keep up with your dental appointments.
The NHS specifically recommends good oral hygiene because people with dry mouth are more prone to tooth decay. (nhs.uk)
There are also products available from pharmacies designed specifically for dry mouth.
You will find them as gels, sprays, tablets and lozenges.
They don’t necessarily correct whatever caused the dry mouth in the first place, but they can make the symptoms much easier to live with.
A pharmacist can help you choose an appropriate product. (nhs.uk)
Don’t ignore other symptoms
Most dry mouths aren’t caused by anything sinister.
But if the problem persists, it is sensible to look for the reason.
Diabetes can be associated with dry mouth, as can conditions such as Sjögren’s disease. (NIDCR)
So if someone has persistent dry mouth together with symptoms such as excessive thirst, needing to urinate frequently or unusually dry eyes, that deserves a conversation with a doctor.
Likewise, a painful, swollen or bleeding mouth, persistent taste changes, difficulty eating or talking, or white patches in the mouth shouldn’t simply be put down to being thirsty. The NHS advises seeking medical advice when these symptoms occur. (nhs.uk)
A small symptom worth listening to
One thing I have learned working in community pharmacy is that people often come in with what they consider to be a very minor problem.
Sometimes it is.
But occasionally that small problem is a useful clue.
A dry mouth might simply mean you haven’t had enough to drink.
It might be the result of sleeping with your mouth open.
It might be a side effect of one of your medicines.
Or it could be pointing towards another problem that needs investigating.
So if your mouth occasionally feels dry, have a drink and carry on.
But if you are constantly reaching for the water bottle and your mouth still feels dry, don’t just accept it as part of getting older.
Have a chat with your pharmacist.
Check your medicines.
Look after your teeth.
And if it persists, get it checked.
Sometimes the simplest symptoms are worth asking a few more questions about.
Until next time, look after yourself.
This article is for general health information and is not intended to replace individual medical advice.
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