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Mouth dryness, known as xerostomia, is commonly thought of as a normal part of aging. But that’s not true. Healthy adults continue to produce adequate amounts of saliva, but some medical conditions and certain medications can lead to dry mouth—and that can be more dangerous than you might think.

What most people don’t realize: Dry mouth is more than a mere annoyance. It significantly increases risk for infection (including gum disease) and severe tooth decay. And treating the teeth does not solve the problem of dry mouth.


Saliva is mostly water, but it also contains enzymes that break down food particles. It inhibits the growth of bacteria that can damage tooth enamel and is crucial for preventing fungal infections in the mouth. Saliva also lubricates the mouth so that we can speak and swallow.

If you don’t produce enough saliva, you will, of course, notice mouth dryness. Other symptoms include cracks in the lips or the corners of the mouth, bad breath, burning of the mouth, a dry feeling in the throat and an increase in tooth decay and/or gum disease.

Self-test: You’re probably producing normal amounts of saliva if you can chew a dry cracker and swallow it easily. People who consistently struggle to eat and swallow dry foods have a problem.

If you have dry mouth, your physician or dentist may want to measure your output of saliva with a Lashley cup, a device that fits over the opening of the parotid duct (the primary duct of the major salivary gland). Salivary flow is stimulated with a citric acid solution that is applied to the borders of the tongue with a cotton swab. Saliva is then collected. A healthy adult should produce between 0.5 cc and 1.2 cc of saliva (about one-tenth to one-quarter of a teaspoon) per minute per gland when stimulated.


Sjögren’s syndrome, an autoimmune disorder, is a common cause of mouth dryness. This disease damages the glands that produce saliva and can cause swelling and pain in the joints.

Other causes of xerostomia…

  • Radiation treatments for oral or neck cancers can permanently damage cells in the salivary glands. Example: Radiotherapy that’s used to treat oral cancer kills saliva-producing cells as the beam passes through the salivary glands.
  • Medication use. According to the Surgeon General’s report on oral health in America, more than 400 prescription and over-the-counter (OTC) drugs cause mouth dryness as a side effect. Common offenders: Antihistamines, antidepressants, decongestants and diuretics and other blood pressure drugs.It’s rare for a single medication to cause significant dryness (though it can happen). The risk multiplies when patients are taking multiple medications that have mouth dryness as a side effect.To find out if a medication you are taking may cause mouth dryness: Check the Web site for the Physicians’ Desk Reference,
  • Mouth-breathing. Some people tend to breathe through their mouths, which can cause dryness even if they produce normal amounts of saliva. This usually occurs in those who have some kind of nasal obstruction, such as a deviated septum, or the breathing disorder sleep apnea.To check yourself for mouth-breathing at night: Notice whether your mouth feels dry in the morning. People who mouth-breathe tend to experience the most dryness when they first wake up.
  • Dehydration. You need adequate amounts of fluids to produce saliva. Most people get enough water from beverages and food, but older adults often forget to drink enough water.

Other causes of dry mouth include uncontrolled diabetes. Frequent urination (a symptom of diabetes) may lead to dehydration and dry mouth.

Interesting: Some people who believe they have dry mouth actually produce normal amounts of saliva but may, in fact, suffer from depression or anxiety. That’s why it’s important to discuss your symptoms with your doctor and perhaps get tested.


If you and your doctor determine that your mouth dryness is caused by medication, ask about switching to a drug and/or dose that doesn’t have this side effect. Also helpful…

  • Try a saliva substitute that contains carboxymethylcellulose or hydroxyethylcellulose. Such products, which are sold OTC at most drugstores in solutions, sprays, gels and lozenges, can be used as needed to replace moisture in the mouth. Good choices include Optimoist…Biotene Moisturizing Mouth Spray…and Entertainer’s Secret.
  • Chew sugarless gum and suck on sugarless hard candies to help increase saliva flow. Hard lemon drops are a good choice because the sourness stimulates more saliva.
  • Drink more water or suck on ice cubes to moisten your mouth and increase your fluid intake.
  • Use a dry-mouth toothpaste such as Biotene. It doesn’t increase saliva, but it may relieve burning sensations caused by mouth dryness and is less likely to irritate dry tissues in the mouth than other toothpastes. It also has mild antiseptic properties, which can help prevent tooth decay or gum infections.
  • Avoid mouthwashes with alcohol. Some products contain more than 25% alcohol. Alcohol is a desiccant that dries tissues in the mouth. If you use a mouthwash, buy an alcohol-free version—and use it only once a day.
  • Protect your teeth with fluoride. I advise patients who are scheduled for—or have already had—radiation treatments of the head or neck to apply fluoride gel to the teeth. Your dentist can make plastic dental trays and provide the gel. Applying fluoride for five to 10 minutes daily will help prevent tooth decay that may result from excessive mouth dryness.