Medicines that dry the mouth, and your teeth

Saliva does more than keep the mouth wet

Saliva works quietly all day. It rinses food debris away, dilutes the acid that bacteria produce, carries minerals back into the enamel and keeps the tissues of the mouth gliding over each other. Tasting, swallowing and speaking all depend on it. When the flow drops, every one of those jobs weakens at once: the mouth is not only dry, it is also less protected.

Which groups of medicines dry the mouth

Dry mouth is a well recognised side effect of a long list of medicines rather than of one drug. The mechanism is usually the same: these medicines dampen the nerve signal that drives the salivary glands. The groups below appear most often in patient leaflets, and the list is not exhaustive.

• Allergy medicines, that is antihistamines
• Antidepressants and some other mental health medicines
• Blood pressure tablets and diuretics, often called water tablets
• Medicines for incontinence and an overactive bladder
• Strong painkillers and muscle relaxants
• Asthma inhalers, anti-sickness and travel sickness tablets

One medicine on its own often leaves the mouth only slightly dry. Take three or four together and the effect adds up, which is why dryness stands out in people on several long term prescriptions and in later life. Dryness that appears in the weeks after a new medicine is started is often linked to it, though only the doctor who prescribed it can say so with any certainty.

What you notice when the mouth dries out

The symptoms go well beyond a dry feeling. The tongue sticks to the palate, dry bread is hard to swallow without a sip of water, the voice grows hoarse and flavours turn flat. Waking in the early hours with a burning tongue is common. Lips crack at the corners, breath grows stale, and a removable denture that used to sit still starts to move. For many people the first clear sign is the glass of water that has appeared on the bedside table.

Saliva flow is already at its lowest during sleep. Drug related dryness is therefore felt most at night, and teeth are least protected in exactly those hours.

Why decay and thrush become more likely

With less saliva, acid lingers in the mouth and the enamel loses its mineral supply. Decay then starts in unusual places, typically along the gum margin and on root surfaces that have become exposed. It can move quickly: a mouth that looked sound six months ago can show new cavities. The same conditions suit yeast, so oral thrush appears as a white coating on the tongue, a burning feeling and cracks at the corners of the lips. Under a denture the palate turns red.

What helps through the day

• Sip water in small amounts all day; one large glass does not hold the dryness off for long.
• Chewing sugar-free gum lifts saliva flow within minutes.
• Cut back on coffee, tea and alcohol; smoking makes dryness markedly worse.
• Try to breathe through the nose; sleeping with the mouth open adds to morning dryness.
• A humidifier in the bedroom can ease night-time symptoms.
• Pharmacies stock saliva substitute gels and sprays; ask the dentist which one suits you.

The riskiest habit is reaching for a sweet or acidic drink to relieve the dryness. Juice or a fizzy drink sipped through the day leaves an unprotected tooth sitting in acid for hours. For thirst and for wetting the mouth alike, water is the safer choice.

What changes in your dental routine

Standard care is not enough in a dry mouth. Brushing twice a day with a fluoride toothpaste is the basis, and the dentist can prescribe a higher fluoride paste and apply fluoride varnish at check-ups. Check-up intervals are usually shortened, because new decay has to be caught early. Cleaning between the teeth carries on as before, and a denture comes out at night and is cleaned.

What the dentist needs to hear from you

Bring an up to date list of everything you take to the dental appointment, including allergy tablets bought over the counter and herbal supplements. Saying when the dryness began and which change in medication it followed cuts out a great deal of guesswork. If medicines do not explain it, something else may: conditions affecting the salivary glands, radiotherapy to the head and neck, poorly controlled diabetes and mouth breathing are the usual candidates. If swelling in the cheek or face comes with a fever, seek dental or medical care the same day.

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