Xerostomia

Also called Dry mouth

A mouth that does not make enough saliva. Usually a medication side effect, and it wrecks teeth, eating and speech.

What it is

Dry mouth sounds minor. It is not, and in care settings it is one of the most common untreated problems there is.

Saliva does more than moisten. It washes away food, neutralises acid, carries the minerals that repair enamel, controls bacteria, and makes swallowing and speaking possible. Without it, teeth decay quickly, dysphagia worsens, dentures stop fitting and speech becomes difficult.

The usual cause is medication. Over 400 drugs list dry mouth as a side effect, including many antidepressants, antipsychotics, antihistamines, diuretics and drugs for bladder problems. Radiotherapy to the head and neck, Sjögren's syndrome and dehydration also cause it.

Signs you might notice

A sticky, dry mouth. Lips cracking at the corners.

Difficulty chewing, swallowing or speaking, especially dry food.

A burning tongue, altered taste, bad breath.

Rapid tooth decay, particularly at the gum line, and dentures that rub or will not stay in.

Thrush, and a sore red mouth.

How it can affect day-to-day life

The dental damage happens fast and is irreversible. Somebody on several drying medicines can go from a healthy mouth to multiple extractions in a couple of years.

For people who cannot report symptoms, dry mouth shows as refusing food, distress at mealtimes, or behaviour that gets recorded as challenging.

Oral care is also infection control. A dry, dirty mouth plus aspiration is what turns a swallowing problem into pneumonia.

Supporting someone well

Look in people's mouths. Daily. This is the recommendation most often ignored in care settings and the one that finds the problem.

Review medication with a pharmacist. Sometimes a timing change or an alternative drug is possible, and nobody asks.

Keep sipping water through the day, and use sugar-free saliva substitutes or gels, especially at night.

High-fluoride toothpaste, prescribed, for anybody at high decay risk. Brush twice daily with a small-headed brush, and do not rinse afterwards.

Avoid sugary drinks and sweets used to stimulate saliva. Sugar-free gum is better where the person can manage it.

See a dentist regularly rather than in crisis. Domiciliary and special care dentistry exist for people who cannot attend.

Fiducia Together keeps oral care in the clinical record beside the medicines, which is how a drying drug and a deteriorating mouth get connected by the person doing the review.

Where to get help

A GP or pharmacist can review medication. A dentist can prescribe high-fluoride toothpaste and saliva products.

For people who cannot attend a surgery, ask about community special care dental services.

Persistent dry mouth with dry eyes and joint pain may be Sjögren's syndrome and needs investigating.