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

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?

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.