I see dozens of patient every week for the problem of overactive bladder or when you gotta go, you gotta go! The side effects from the medications used to treat overactive bladder are often accompanied by the problem of dry mouth or xerostomia. Not only does medication cause this problem but also there are other common causes of this disabling condition. In this article, I will review the cause of dry mouth and provide some treatment options for this common problem.
Dry mouth can be defined as a lack of saliva flow resulting in an uncomfortable or in some cases a debilitating condition. 17-29% of adults experience dry mouth. Dry mouth is not a trivial condition. It can be painful and have a profound impact on oral health and a person’s quality of life.
Other Symptoms Occurring With Dry Mouth
Dry mouth is accompanied by bad breath, or halitosis, but also increases the risk of dental cavities or caries. Because dry mouth alters the normal bacteria in the mouth, the risk of infections, such as candidiasis, also increases. Since there is a decrease in saliva, which is necessary to mix with food that is to be swallowed, swallowing can difficult. People with dry mouth may have difficulty talking. Finally, those who complain of dry mouth also report that there is a decrease in the sense of taste making eating less enjoyable.
Visually, you will notice the mucosal tissues becoming red and parched in the case of dry mouth. The inside of the mouth may be sticky, with cracking at the corners of the mouth, and the tongue may appear reddened, or take on a ‘pebbled’ appearance.
Causes of Dry Mouth: Medication
Millions of Americans are affected by dry mouth, especially women, older people and those using any of the 400 commonly prescribed drugs that list dry mouth as a side effect. For example, many of the drugs used to treat overactive bladder are associated with the side effects of a dry mouth. However, with treatment most of the patients taking these drugs do not have to discontinue the use of the medication used to treat their overactive bladder. Taking more than one medication may increase this risk of dry mouth.
Certain kinds of drugs are more prone to cause dry mouth symptoms. The most commonly implicated are tricyclic antidepressants, antipsychotics, benzodiazepines, atropine containing drugs, beta-blockers and antihistamines. Most are prescription, but even over-the-counter drugs can cause dry mouth symptoms such as antihistamines, decongestants, cough and cold remedies, analgesics and anti-nauseants.
Dry mouth, has been ranked as the third most distressing symptom of therapy for head and neck cancer. Surgery, radiotherapy and chemotherapy can all cause symptoms of dry mouth, and sometimes dry mouth can be permanent.
Radiotherapy causes the most damage to the salivary glands. In the first week after radiotherapy, saliva flow reduces by 95% and ceases almost entirely within five weeks. Two-thirds of radiotherapy patients who survive three years are still suffering from chronic dry mouth. Chemotherapy also reduces saliva flow, but the effects are relatively short-lived.
Dry mouth can be a symptom of several diseases, and is often seen alongside other reduced secretions such as dry skin, dry eyes, blurred vision and vaginal itching.
Sjögren’s Syndrome — a disease where the body’s immune system attacks salivary glands and tear ducts — is one of the greatest causes of dry mouth. It is estimated to affect seven million Americans, 90% of them women, with an average age of 50. Other diseases known to cause dry mouth symptoms include rheumatoid arthritis, systemic lupus erythromatosis and sarcoidosis.
Diabetes is another common cause of dry mouth symptoms and hyposalivation. Chronic dry mouth could be due to the body excreting water through increased urination, or from some underlying metabolic or hormonal problem.
Smoking or chewing tobacco can affect saliva production and aggravate dry mouth. Continuously breathing with your mouth open can also contribute to the problem.
Unbrushed teeth have food particles around them that promote bacteria and cause bad breath. Persistent bad breath or a bad taste in your mouth may be from continuous breathing through your mouth, dry mouth, a sign of gum disease, or even diabetes. Fight bad breath by brushing your teeth and tongue, and drinking water.
If you think your dry mouth is caused by certain medication you are taking, talk to your doctor. He or she may adjust the dose you are taking or switch you to a different drug that doesn’t cause dry mouth.
In addition, an oral rinse to restore mouth moisture may be prescribed. I have recommended that patients with overactive bladder complaining of dry mouth, gargle with Biotene, which is an over the counter mouth rinse. If that doesn’t help a medication that stimulates saliva production, called Salagen, may be prescribed.
Other steps you can take that may help improve saliva flow include:
Sucking on sugar-free candy or chewing sugar-free gum, drinking plenty of water to help keep your mouth moist, protecting your teeth by brushing with a fluoride toothpaste, using a fluoride rinse, and visiting your dentist regularly, and using a room vaporizer to add moisture to the bedroom air
Bottom Line: Dry mouth is a common problem and can lead to other problems if it is not treated. Simple lifestyle changes will often help. If these changes do not help and the over the counter medications are not effective, see your dentist if bad breadth persists.
Dr. Neil Baum's Urology Blog 