Q. I am having chronic dry mouth. What is the treatment?

Answered by
Dr. Shyam Kalyan N
and medically reviewed by iCliniq medical review team.
Published on Oct 22, 2019 and last reviewed on: Oct 28, 2019

Hello doctor,

I have a chronic dry mouth. I have consulted two ENT specialists and looking for another opinion. Two years ago, I started to get a dry mouth when I was nervous (it is soon after I got a hair transplant, and I was very conscious of my image and recovery). That was the first time I ever experienced a dry mouth.

Unfortunately, the dry mouth had developed into a more prominent and chronic issue (even when I am not nervous or anxious) and is now present almost all of the time. Generally, it feels like I do not have enough saliva, or it is foamy. I am very conscious of it when I talk, and it does prevent me from talking a lot. If I sweat more than usual, my mouth will become dry. I try to drink one to two liters of water a day, but it does not make too much difference.

The only time I do not have a dry mouth is when I am eating or drinking, and for about 15 minutes afterwards.

I have got many blood tests done, and all are in range except for neutrophils, which is slightly below range at 1.5, but this appears to be normal for me, and the hormone estradiol is also below range. The doctor has ruled out Sjogren's syndrome or autoimmune also.

Both ENT doctors said that this would clear up by itself, and that was possibly anxiety related. I did go on SSRIs for one year, but this made my dry mouth much worse. One of the ENT doctor said to try lemon and lime juice three times a day to encourage the salivary glands to start working properly again, but I have not noticed any difference. I have tried most of the salivary substitutes and gum, but most of them are just temporary fixes. Is there anything else I should do to find the cause like an MRI or CT or any other avenue I should explore?

Dr. Shyam Kalyan N

Allergy Specialist Otolaryngology (E.N.T)
#

Hello,

Welcome to icliniq.com.

Dry mouth can be a very distressing thing. However, I need to know certain details. Kindly be as objective as possible when you answer.

1. When the SSRI (selective serotonin reuptake inhibitors) started for this purpose? Do you have a doctor's prescription detailing the same?

2. Are you still on SSRI?

3. Is there any other sort of anxiety or worry?

4. Is there any difficulty or burning sensation while chewing or swallowing?

5. Is there any lump sensation or choking feeling in the throat?

6. Do you get a good sleep in the night?

7. What is your height in centimeters and weight in kilograms?

8. Do you snore?

9. Have you tried saliva sprays?

10. Do you smoke or drink or use any drugs? Do you smoke weed or chew tobacco?

11. Do you suffer from diabetes or blood pressure or hypothyroidism for which you have to take medicines regularly?

12. Is there any oral sexual practice that might be causing such a dryness?

13. Could you take a picture of an open mouth showing details of the oral cavity and send me?

We shall help you find a solution to this problem. But please provide as many details as possible so that we arrive at a decisive diagnosis. If possible, kindly upload the opinions of previous ENT specialists.

Thank you doctor,

I have answered your questions in the same order.

1. Doctors advise is one of the reasons I started SSRIs. Around the same time, the dry mouth began, and my anxiety and depression were very prevalent (nervousness, paranoia, on edge, etc.). I have always been prone to performance anxiety and some low moods, but post my hair transplant surgery, it rose to levels I had never experienced before. I do not have the doctors prescription, but they tried me on Sertraline for six months and then Lexapro for six months. I stopped both before ten months.

2. I stopped SSRI before ten months after spending one year on two different SSRIs. They slightly helped the anxiety but made my dry mouth unbearable so much it became red and sore on the roof of my mouth.

3. I am generally an overthinker and a sensitive person. I do get performance anxiety both sexually and when speaking publicly or when I am uncomfortable. I have some level of social anxiety. I am working with a CBT therapist for the past two years to help with this, and I am generally in a much better place than I was in before ten months and when I was on SSRIs.

4. No difficulty and burning sensation while chewing and swallowing.

5. There is no lump sensation or choking feeling in the throat.

6. Generally, I will get around 7-8 hours of sleep at night, but I never feel rested and usually look tired under the eyes. I wake one or two times at night to urinate. I have never in my life slept from night to morning without urinating. I was a bed wetter until my teens which may have something to do with that.

7. I am 185 cm in height and weighs about 86 kg. My BMI is 25, and I am actively trying to reduce this.

8. I do not snore, but sometimes I do wake up as it feels like I was holding my breath or breathing very fast. I also wake with palpitations every morning and even if I go for a nap.

9. I tried saliva sprays and found them very temporary. I also find for the nature of my dry mouth that it makes my saliva thicker.

10. I do not smoke anymore. I quite after I began to have a dry mouth two years ago. I rarely drink two to three beers every month. Alcohol and smoking make my mouth unbearably dry and foamy. I do not take drugs anymore and quit before three years. I never had tobacco.

11. My blood sugar is normal and no thyroid issues. I recently did a 24-hour blood pressure test, which is normal.

12. I do not have any oral sexual practice.

13. I have sent a picture of an open mouth.

I do not have any written opinions of the ENT but in summary:

First ENT (consultant): Checked blood results from GP and did a physical examination of jaw and mouth. Advised that there were many cases much worse than me, and there was slight swelling of the salivary glands under the chin, but that was due to the fact they were compensating for others. He advised to try swishing lemon and lime juice around mouth three times a day for six months, and it may help.

Second ENT consultant ruled out Sjogren's syndrome. Did physical examination and said it looks like it was caused by anxiety and that it should sort itself out over time. He did remark that it was quite strange for it to start so suddenly and then remain chronic.

Dr. Shyam Kalyan N

Allergy Specialist Otolaryngology (E.N.T)
#

Hello,

Welcome back to icliniq.com.

Thanks for taking the time and giving detailed replies to the questions. I went through each reply of yours as well as the pictures you uploaded. (attachment removed to protect patient identity).

In the pictures, I can see healthy oral cavity and oropharynx mucosa, normal-appearing teeth which are majorly clean as well, normal hard palate and soft palate, a normal-appearing upper surface of the tongue, normal-looking frenulum and under the surface of tongue, normal-appearing submandibular salivary gland duct papillae. Majorly the mucosa appears most as well.

My suggestions are if you could try and see if this helps.

1. Start on good multivitamins, which include zinc, magnesium, and other trace elements as well.

2. Take a chewable tablet of vitamin C daily.

3. Take Cod liver oil supplements.

4. Take probiotic curd daily. While having your curd, keep the curd in the oral cavity for about two or three minutes and move it around the mouth and swallow gradually.

5. Try having plenty of fruits in your diet. Lemon and other citrus fruits mainly.

6. Try incorporating green leafy vegetables in your diet.

7. Drink more water. Have at least four liters of water daily. Some of it can be lemon juice or citrus water.

8. Avoid excess spice and salt in your diet.

Kindly let me know how you feel. I hope this helps.

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