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What to do about a "dry mouth"
R Swamy Venuturupalli, MD, FACR posted:
Dry mouth is a common symptom that afflicts numerous older adults. Additionally, patients with connective tissue diseases such as lupus and rheumatoid arthritis often suffer from severe dryness of the eyes and mouth. Sjogren's syndrome is the prototypical autoimmune disorder that is associated with severe dryness of the eyes and the mouth. Primary Sjogren's syndrome is a progressive systemic autoimmune disease in which there is early and gradually worsening of salivary and lacrimal (tear producing) glandular function. This condition afflicts women more than men in a ratio of approximately 8:1, and it seems to affect women in the perimenopausal age group.
Saliva is produced by the salivary glands. It is an important digestive fluid that initiates digestion of food even before food reaches the stomach. The major salivary glands are the parotid glands and the submandibular glands. However, numerous additional salivary glands are present in the tongue and the soft tissues of the oral cavities. When saliva production is decreased, it leads to several uncomfortable symptoms including, thickened saliva, bad breath, cavities and oral infections, as well as poor digestion due to the absence of adequate saliva.
When someone experiences symptoms of dry mouth, the first step is to investigate and establish the cause for the dry mouth. The most common cause of dry mouth are medications such as antidepressants, antihistamines, anti-seizure medications are associated with dryness of the mouth. Exposure to radiation therapy for head and neck cancer treatment, diabetes, HIV or hepatitis C infection are all associated with dryness of the mouth. Autoimmune diseases such as Sjogren's syndrome, lupus, scleroderma and rheumatoid arthritis are also associated with significant dryness of the mouth.
Usually a dry mouth doesn't result in oral pain. Usually, when there is pain associated with a dry mouth, thrush or candidiasis need to be ruled out. This is a fungal infection by the organism called candida albicans (the same fungus that causes diaper rash). Risk factors for the development of a painful mouth include antibiotic treatment of treatment with glucocorticoids. Treatment of oral candidiasis usually requires prolonged treatment with oral anti-fungal medications.
A related but distinct condition is "burning mouth" syndrome. The causes for this condition include nutritional deficiencies such as B-complex vitamins, diabetes, hormonal changes seen with menopause, some medications, though usually it is difficult to find an exact cause and it is attributed to a localized nerve damage (neuropathy).
I recommend the following measures for management of dry mouth:
1. 1. Identify offending medications and try to change them. In general, more medication = more chance of dry mouth.
2. 2. Drink plenty of water throughout the day and keep water at the bedside at nighttime.
3. 3. Suck on sugar free gum or hard candy- the sucking motion stimulates saliva
4. 4. A drop of lemon juice just prior to a meal on the tongue can stimulate saliva flow.
5. 5. Avoid mouth rinses that contain peroxide or alcohol as these can cause worsening of symptoms
6. 6. Avoid foods that are salty and dry and use foods that are moist, soft and not very hot.
7. 7. Avoid alcohol, sugary beverages and acidic beverages.
8. 8. It is extremely important to prevent tooth decay. This requires compulsive attention to oral hygiene including brushing after every meal, flossing every night, using toothpaste with fluoride and visiting your dentist every 6 months.
9. 9. Use a humidifier at night to improve humidity at home.
10. Use omega-3 supplements to decrease inflammation that may be associated with autoimmune diseases.
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lisaisweavebee responded:
What great information! Thank you for sharing!

MaryConcordNC responded:
I have Lupus with secondary Sjogren's. Above info is very helpful. I read recently in AARDA about a study which showed positive results for gum with green tea extracts and Xylitol, and now I'm using Mighteaflow from Camellix. They also have lozenges. I do think they are helpful.
I also use Evoxac, which was prescribed by my rheumatologist. It is effective, but has many side effects, one of which is increased urgency and frequency in urination.
yogogal replied to MaryConcordNC's response:
I use Pilocarpine which is my life saver. There can be some minor side effects but iIf I had to pick only comfort medication I could keep, it would be that. I have secondary Sjogrens, which were the first symptoms I had before being diagnosed with SLE

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