Hello Doctor:
First, I'd like to applaud your website for the help it provides. For people such as myself who are so infrequently ill that they wouldn't know a symptom that warrants a doctor's attention versus that of a minor illness, these forums are quite educational.
My specific problem is that of dry mouth. I have questioned every doctor (general practitioner) and dentist I've been to regarding my problem, and have yet to find any help. Most recently, during a visit to my primary care physician for pharnygitis, I again questioned him on my dry mouth and what might I take that would stimulate an increased saliva flow. He mentioned reading or hearing that zinc supplements might be helpful. So, I'm giving that a try at 100mg/day.
Originally from Tennessee, I have been living in Texas for 13 years and could guess that my problem with dry mouth started shortly after moving to Texas. I've had this problem so long that I can't honestly remember when it started. If it came from my relocation to Texas, I question if there might be something in the air that I'm having an allergic reaction to; it would have to be a year-round thing, if this is true.
My condition is best described as a nighttime problem, finding myself waking up in the early morning hours with what is a completely cotton-dry mouth...throat, gums, tongue, etc. Even if I drink 6-8 ounces of water, that serves only to moisten my mouth before it is again dry within 5-10 minutes. I know that I do not drink the often recommended 8-10 glasses of water per day, but even when I have managed to establish that practice, there was still no observable change in my dry mouth. At present, the only solution I have found is to keep a stick of sugarless gum by my bed. Then, when I first wake up, I begin chewing the gum. That usually gives me the needed relief, but not always.
If I sleep with my mouth open, then that could surely be contributing to the problem. Lately, I have noticed that my mouth does seem to be opening slightly as I'm beginning to drift off to sleep. I also know that my nose is often congested on one side at night; decongestants, though they may relieve my congestion and allow me to breathe freely through my nose, don't seem to encourage my sleeping with a closed mouth. I've tried looping a headband vertically around my jaw and chin, to encourage me to keep my mouth closed while sleeping. Needless to say, the headband has never remained on during the course of a night's sleep. To attempt such efforts to "train" me into sleeping with a closed mouth, I need some kind of comfortable fixture that isn't so easily pulled off as a headband. I may have to try making something, as I'm not aware of anything available. Of course, this all assumes my mouth is open nearly all the time that I'm sleeping, and I'm not convinced that it is.
As for my sleeping posture, I'm single, so I can't describe it. I don't know if I sleep on my back or side the most, but would guess my back. I would think that if sleeping posture contributes to the problem, it would almost correct itself; that is, in a sleeping state, I would think one's discomfort would cause them to shift sleeping positions that yield more comfort.
Questioning my doctor about this, my only thought was related to dry mouth symptoms of diabetics. Given no other symptoms that would suggest I am diabetic, he ruled that out. We did try a thyroid test, I believe called a "TSH" test, to see if that would reveal anything. The good news was that the test was completely normal; the bad news was that I was no closer to a solution to this very aggravating problem.
To make matters even worse, I feel certain that my dry mouth problem only further aggravates my mouth/throat health when suffering from other illnesses. My current case of tonsillitis/pharyngitis is a good example. This has evolved from a illness that began 17 days ago with a fever, a couple of white spots in my throat, and some lower neck aches. Unconfirmed as a bacterial or viral infection, my treatment began with a prescription of Amoxicillin. With little improvement and a fever stilll present, a change to Erythromycin followed 1 week later. The next day, I noticed swelling of my left tonsil and an increased amount of discharge visible on it, along with pain referenced to my ear. Diagnosing this as tonsillitis, my doctor has kept me on the Erythromycin, along with the recommendation of saltwater gargles. Over the past weekend, the swelling of the left tonsil is down slightly, the right tonsil is very slightly swollen, my fever is up at night/down in the morning, and I'm now feeling sharp pains down into my chest when I swallow. A phone call to my doctor has resulted in him suspecting pharyngitis and extending my antibiotic prescription.
Throughout this illness of course, the dry mouth has been ever present. With irritated tonsils, I expect the dryness can only aggravate the situation. Perhaps it has contributed to my illness developing and spanning the period of time that it has. For a person who is generally in very good health, I tend to become an "impatient patient" when facing an illness that doesn't respond to medicines that typically work quite well for me (especially E-mycin). If my dry mouth is indeed delaying the improvement of my mouth/throat health, then it obviously becomes something of even greater concern for me to get control of.
One final thought...diet. Not the best or the worst, the only unique thing I might identify about my diet is that I do favor diet sodas, sugarless gums, etc. that contain Nutra-Sweet (aspartame). I don't know if my dry mouth problem is older than my initial use of such products, but I've questioned whether aspartame might possibly cause dry mouth in some individuals. Neither my doctor or dentist is aware of such side-effects, and I've not noticed any improvment in my dry mouth when I've stopped drinking diet sodas for a short while. Just a thought.
Thank you for taking the time to read this lengthy letter. I wanted to identify the various things I've considered and/or tried in attempting to resolve my dry mouth problem. Any new insights, advice, or recommendations you have to offer are very much appreciated.
Thanks again,
Reply: ---------------------
There are many, many, possible causes of dryness of the mouth (xerostomia). This symptom can occur simply from habitual mouthbreathing at night. Sometimes mouthbreathing results from orthodontic malformation or nasal airway obstruction. Since the nose is responsible for warming and humdifying the air we breathe, mouthbreathing will lead to xerostomia. Medications are common causes of xerostomia - antihistamines, diuretics, blood pressure medication, etc. Metabolic disturbances including diabetes, lipid disorders, thyroid disease, etc. can all be associated with dry mouth. Dental disorders or dental preparations (mouth rinses, toothpaste,etc.) can cause dry mouth. Oral inflammatory disorders could cause dry mouth. There are certain rheumatologic conditions that can be associated with dry mouth - most notably one called Sjogren's syndrome which usually affects all moist tissues including the eye. Etc.,etc. Suffice it to say that only a comprehensive evaluation would be likely to diagnose the problem and even then the cause may be elusive. It is generally straightforward to rule out the serious illnesses however. Assuming they have been ruled out - symptomatic treatment may be all that can be provided - sialogogue measures such as lozenges, chewing gum, plenty of fluids, proper humidification, avoidance of drying medication, etc.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
Click here to review
previous Ear, Nose and Throat Clinic consultations