Dry mouth: Causes and remedies

What is dry mouth?

Your mouth feels parched. Your tongue sticks to the roof of your mouth and you feel a lack of saliva in your mouth. You can barely swallow or speak and are incredibly thirsty. Sudden dryness in the mouth might be unpleasant but is not usually a cause for concern. After all, it tends to disappear just as fast as it appears.

However, if you live with a dry mouth all the time and are constantly thirsty, even though you drink enough, the condition is referred to as xerostomia. The technical term for dry mouth is derived from the Greek words ξηρός and στόμα, meaning: Dry and mouth. The salivary glands do not produce enough saliva to keep your mouth moist (also referred to as hyposalivation) leading to a constant feeling of dryness in your mouth. 

Symptoms and possible problems associated with dry mouth

Xerostomia is not a health condition, but rather a symptom of another issue. It is usually the result of a certain lifestyle, underlying diseases or medications. Problems associated with dry mouth can be:

• Sticky feeling in the mouth
• Trouble swallowing
• Difficulty speaking
• Residue or tingling sensation on the tongue
• Thirst (intense and constantly)
• Feeling of dizziness
• Bitter taste in the mouth
• Dry eyes
• Dry mouth

• Dry lips
• Loss of taste
• Cracks at the corners of the mouth
• Bad breath
• Inflammation of the oral mucous membranes
• Small lesions in the oral cavity
• Dry and sore throat
• Burning mouth syndrome

Why is saliva so important?

Your body produces between 0.5 and 1.5 litres of saliva daily in three pairs of major and numerous minor salivary glands – a unique mixture that consists of 99 percent water and contains many important enzymes, antibodies and minerals.

An absence of saliva in the mouth can lead to various oral issues: There is a lack of moisturising and cleansing action provided by a normal salivary volume. Saliva not only keeps your mouth nice and moist, it also helps protect against dental decay and periodontitis. It flushes food debris, bacteria, germs, fungi and viruses into the digestive tract, where stomach acid renders them harmless.

Further, the enzymes in saliva break down food, allowing you to swallow it. In a dry mouth, bacteria and other harmful microorganisms can grow surprisingly well and attack and damage your teeth and entire oral cavity. This ultimately results in persistent bad breath and infected oral mucous membranes. Hard foods are no longer broken down and softened by saliva and can injure the oral cavity and throat when swallowed.

Causes: What are the causes of dry mouth?

It is perfectly normal to occasionally have a dry mouth. Most of the time it will be down to stress or an unhealthy lifestyle. However, dryness in the mouth could also be a sign of a serious illness or an unwanted side effect of certain medications. Discover below why you might have a dry mouth.

Lifestyle and daily routines

Dehydration

Not drinking enough fluid is a common reason for dry mouth. To produce enough saliva, your body needs to stay hydrated. Adults roughly need to drink at least 1.5 litres of water a day, although the actual amount depends on a person’s height and weight, their level of activity and the current ambient temperature. If you fail to drink enough water, the water-salt balance in your body becomes disturbed and the oral mucous membranes dry out.

Mouth breathing

When you have a cold and your nose is blocked, you automatically breathe through your mouth instead of your nose. Stress and excitement can also cause us to start breathing in and out of our mouth. The inhaled air dries out the oral cavity. 

Stress and excitement

A feeling of a lump in your throat and a dry mouth are normal reactions when faced with an unpleasant or difficult conversation or before a major performance. This is related to the autonomic nervous system, which perceives the situation as a danger and selectively shuts down certain body functions. As soon as you start to relax and have had a glass of water, the feeling of dryness in your mouth also disappears.

Alcohol and caffeine

The morning after a night out and drinking one too many alcoholic drinks, your mouth might feel as parched as a desert. The symptoms of a hangover include nausea, a headache and severe thirst, as well as a dry mouth. Alcohol is a cytotoxin that depletes the body’s fluids. Your mouth might also feel dry after enjoying a cup of coffee or tea, as caffeinated drinks tend to dry out the oral mucous membranes.

Smoking

Smoking constantly increases the risk of dry mouth. Nicotine is a potent vasoconstrictor. This has an adverse effect on the circulation of blood and restricts the production of saliva. Further, nicotine particles in tobacco smoke cause the oral mucous membranes to dry out even more.

Dry air and loss of fluids

Your skin most probably feels drier in the winter than in the summer. Warm air from heaters causes moisture to be removed from your body at a faster rate, something you may also notice in your mouth. So it comes as no surprise to learn that many people experience dry mouth during the cold winter months. However, the same also applies to air-conditioned rooms in the summer and to fluid loss from heavy sweating (for example when playing sports).

Dry mouth after brushing your teeth

Some high-street toothpastes cause the mouth to dry out. It is therefore important to use a good quality toothpaste that boosts saliva production and keeps the mouth moist.

Calcium-rich water 

Not all water is the same. If your mouth feels dry after drinking water, the calcium content of your water is probably very high. 

Spicy food

If your mouth feels dry after eating food, you might have added too much spice to the dish. The ingredients of a variety of spicy seasonings, such as chillies, make the oral cavity, tongue and throat burn and feel dry.

Ketosis and fasting

People who follow a strict ketogenic or low-carb diet consume a very low amount of carbohydrates. This can lead to them becoming dehydrated very quickly, i.e. losing more fluids than they take in. Glycogen, energy from carbohydrates stored in the liver and the muscles, binds water. If these stores are depleted when following a ketogenic diet and not replenished through food intake, there will be significantly less water in your body than is normally the case. If you are thinking of going low carb, ensure you drink enough water (at least two to three litres a day).

Should you experience a dry mouth when fasting (e.g., a therapeutic fasting regimen of soups or juices) despite drinking enough, it could be down to a lack of chewing opportunities. In fact, the act of chewing actually stimulates the release of saliva. Instead of chewing gum, which can trigger hunger pangs, try a home remedy like lemon water or drink herbal teas when fasting.

Deficiencies

You may have heard that dry mouth could be a sign of a deficiency. But which deficiency causes dry mouth? Especially in combination with burning mouth syndrome, a dry mouth might be a sign of a nutritional problem, such as an iron or vitamin deficiency. It often occurs due to a lack of B vitamins (vitamin B12) or folic acid. 

Why is dry mouth particularly prevalent at night and first thing in the morning?

The body generally tends to produce less saliva in the evening and during the night. So, it is no wonder that your mouth often feels sticky and dry when you wake up in the morning. If you suffer from an extreme dry mouth when sleeping, you most probably snore with your mouth open, thus further drying out your oral cavity. This problem may be exacerbated if you have smoked tobacco, drunk alcohol and eaten spicy food the previous evening.

Dry mouth – a sign of an illness

If the dryness in your mouth fails to improve, it can occasionally be a sign of a more serious illness. In this case, it is best to go and have things checked by a health care professional.

Oral diseases

Inflammations, swellings and tumours in the oral cavity can negatively impact saliva production and the oral mucous membranes. Further, people dealing with dental issues often have problems chewing. This additionally prevents a steady flow of saliva.

• Oral illnesses that reduce saliva production:
• Inflammation of the oral mucous membranes
• Gum disease (gingivitis)
• Inflammation of the periodontium (periodontitis)
• Fungal infection of the oral cavity (oral candidiasis)
• Herpesvirus infection
• Burning mouth syndrome)

Common cold and influenza

When your nose is bunged up, you automatically breathe through your mouth. This commonly results in a dry mouth and throat. A dry cough, headache, fever and sore throat are typical problems associated with dryness in the mouth. Dry mouth usually goes away once the cold symptoms subside.

COVID-19

In a study conducted by the medical journal Future Virology, xerostomia was reported in 60 percent of patients with COVID-19. Dry mouth is an initial symptom of the disease and may persist in long COVID even after the virus has cleared. 

Sjögren’s syndrome and other diseases of the salivary glands

Dry mouth is one of the first signs of the autoimmune disease Sjögren’s syndrome. It is the second most common autoimmune disease after rheumatoid arthritis and falls within the broader category of rheumatic diseases. The body’s immune system attacks fluid-secreting glands, such as the salivary and tear glands.

Other diseases of the salivary gland that prevent a steady flow of saliva:

• Acute inflammation of the salivary gland
• Chronic inflammation of the salivary gland (for example due to an Aids-related illness)
• Salivary gland tumours

Dry mouth due to diabetes

Diabetes mellitus (types I and II) results in a metabolism imbalance and adversely affects the production of saliva. Classic signs and symptoms of diabetes include frequent urination and severe thirst. The body loses critical minerals and water and can become dehydrated. This also leads to the feeling of a dry mouth.

Extreme thirst, frequent urination and dryness in the mouth are also significant signs of the hormonal kidney disease diabetes insipidus.

Dry mouth and mental illnesses

Dry mouth caused by stress will quickly disappear as soon as the stressful situation passes, and you start to relax. However, if the psyche is permanently trapped in fear (for example, in the case of people with anxiety disorders or depression), chronic dry mouth may occur. The decreased flow of saliva results from the sympathetic nervous system being activated by anxiety and stress. Dryness in the mouth is often brought on by panic attacks and a rapid heart rate.

Other diseases that display symptoms of dry mouth

• The following illnesses and disorders reduce saliva production:
• Fibromyalgia
• Diseases of the stomach (e.g. gastritis)
• HIV
• Reflux diseases
• Cardiovascular diseases, coronary heart disease
• High blood pressure
• Disorders of the nervous system

• Overactivity of the thyroid gland
• Liver diseases (e.g. cirrhosis of the liver)
• Inflammation of the pancreas
• Adrenal-cortical disease
• Parkinson’s disease
• Stroke
• Mumps

Dry mouth exacerbated by the side effects of medications

Dryness in the mouth can be an unwanted side effect of many medications. If your chronic dry mouth began when you started taking a certain medication, be sure to tell your health care professional who can then look for an alternative treatment. Since experiencing dry mouth caused by medications can often be avoided. Sometimes it might be as simple as switching to a different product.

However, if you start to experience dryness in the mouth after radiation treatment for cancer, the symptoms often remain permanently. A persistently dry mouth may also develop after surgery if the salivary glands have been damaged. Learn how you can come to terms with dry mouth here.

The following medications and treatments can cause dry mouth:

• Antidepressants and other psychotropic drugs (e.g. sertraline, mirtazapine, amitriptylina and quetiapine)
• Chemotherapy and radiation therapy for cancer treatment
• Antibiotics
• Cortisone (e.g. asthma sprays containing cortisone and prednisolone)
• Medications for cardiovascular diseases and high blood pressure (e.g. the ACE inhibitors ramipril and candesartan and the beta blocker medicine bisoprolol)
• Medications for Parkinson’s disease

• Medications for reflux and heartburn (e.g. pantoprazole)
• Medications for allergies (e.g. cetirizine)
• Medications for nausea and diarrhoea (e.g. vomex)
• Painkillers (e.g. novalgin and tramadol)
• Sleeping pills and sedatives (e.g. tavor)
• Antiepileptic drugs (e.g. pregabaline)
• CPAP therapy for sleep apnoea

Dry mouth is a very common side effect of antidepressant treatment. If you are looking for antidepressants that do not cause dry mouth, it might be worth asking your psychiatrist for some advice.  

Dry mouth in various phases of life

Since the salivary gland reacts to hormonal changes, there are phases of life when dry mouth might be more prevalent. Monthly fluctuations in female hormone levels can also have an impact on saliva production. Women often experience dry mouth just before their periods.

The reasons for dry mouth in children are similar to those in adults.

Dry mouth during pregnancy

During pregnancy, women need to be drinking for two and thus regularly become dehydrated. Morning sickness, which many women suffer from in the early stages of pregnancy, and hormonal fluctuations make dry mouth even worse. Another factor: At least 20 percent of all pregnant women suffer from pregnancy rhinitis, which causes them to breathe through the mouth.

Since dry mouth can have many causes, it is not necessarily an early sign of being pregnant. If, in addition to dry mouth, you are also experiencing nausea, a ravenous appetite and a missed period, it is a good idea to get checked over by your gynaecologist.  

Dry mouth during menopause

Women experience hormone imbalances as they go through menopause. The body produces less oestrogen and this in turn affects the salivary glands. This is one of the reasons why many women complain of dry mouth and burning mouth syndrome during menopause. If these women are also on antidepressants, antibiotics or ACE inhibitors, the symptoms are exacerbated by the respective side effects. Unfortunately, dry mouth does not always disappear after menopause. It is then particularly important to use the right products to cope with this annoying problem.

Dry mouth in old age

It is estimated that approximately 50 percent of the population aged 65 years and older experience chronic dry mouth. This is also down to the fact that saliva production decreases with age. Further, many older patients are prescribed several medications at the same time and do not drink enough. Dry mouth is a common problem experienced by many denture wearers. The reason for this? Poorly fitting dentures make chewing food an agonising ordeal. However, chewing helps stimulate saliva production. As such, reduced chewing performance results in a lower salivary flow rate. 

When should you consult a health care professional?

If you suffer from chronic dry mouth, you should definitely consult a health care professional about it. Since your dry mouth could be a sign of an illness or an unwanted side effect of a certain medication.

This is especially true when the following factors apply:

• You have a persistently dry mouth that does not disappear even after making some healthier life choices.
• Your mouth became permanently dry after you started taking a certain medication.
• You have difficulty chewing, swallowing and speaking.
• Not only your mouth is dry, but also your eyes, nose, lips and throat.
• You notice that your salivary glands are swollen.
• Your dry mouth is not attributable to external factors.
• You are under a lot of stress and feel mentally drained.
• Besides your dry mouth, you have various other symptoms, including bad breath, burning mouth syndrome, loss of taste, pain in your mouth and throat, bleeding in your mouth, nausea and dizziness.

Which health care professional should I see about dry mouth?

As dry mouth involves multiple areas of focus and knowledge, you have three possible options:

• General practitioner
• Dentist
• Ear, nose and throat specialist (ENT specialist)

It is also essential to visit a dentist for a routine check-up every six months. If your dry mouth symptoms are particularly severe, you can also go for a check-up every three months. Because at the end of the day, your teeth are at a greater risk of decay due to a lack of saliva.

Determining dry mouth: The saliva flow test

To determine how severe your dry mouth is, your dentist can perform a saliva flow test. This test helps determine the salivary flow rate. It involves chewing on a paraffin pellet for 30 seconds to stimulate saliva production and the individual depositing the stimulated saliva into a measuring cup. This allows accurate determination of the amount of saliva.

The best products for dry mouth

In most cases, managing and treating dry mouth is easy – especially during the day. Discover the best products for dry mouth here: What really helps and what you can do to keep your mouth pleasantly moist. Quite often a few small tweaks to your daily routine can help a great deal.

Rapid relief: Sugar-free chewing gums and sweets

If your mouth suddenly feels parched, chewing gum or sucking sweets can offer rapid relief. You are basically signalling to your body that there is a substance in your mouth that needs to be digested and it starts generating saliva at a high rate.   

Remember though, the key to healthy teeth is using sugar-free chewing gums and sweets. Chewing gum containing xylitol is doubly effective: This sugarless alternative ensures that the bacteria in your mouth no longer convert sugar into acid, thereby protecting your teeth from dental decay.

Preventing dry mouth

Obviously, it is best to prevent dry mouth before it even occurs. A first step to preventing dry mouth is a healthy lifestyle.

The following measures specifically help fight dry mouth:

• Paying attention to good oral and dental hygiene and using enzymatic toothpastes
• Drinking approximately two litres of liquid a day (water, fruit juice and water mixtures, unsweetened fruit infusions and herbal teas)
• Stopping smoking
• Avoiding alcohol, coffee and very spicy or salty foods
• Avoiding sugary drinks
• Using a humidifier in your bedroom (ideal air humidity level: 40 to 60 percent)
• Eating lots of fruit and vegetables
• Eating lots of soups, stews and dishes with sauces
• Chewing food properly to stimulate saliva production

Home remedies for dry mouth

You can also treat dry mouth naturally with the right home remedies:

Oil pulling

Oil pulling involves placing a teaspoon of oil of your choice into your mouth in the morning before brushing your teeth and having breakfast and ‘pulling’ this oil between your teeth for 15 to 20 minutes. Then spit the oil into a paper towel and throw it in the bin. Oil pulling originated in Ayurveda and is said to detoxify the body but is also good for your teeth and gums.

Lots of people use coconut oil for pulling, but olive oil also helps to combat dry mouth. When choosing an oil, make sure you like its taste. Your entire oral cavity, including your teeth, is moistened with a thin layer of oil when swishing it around your mouth, which, on the one hand, protects your teeth and oral mucous membranes and, on the other hand, provides a pleasant sensation of moisture. Further, oil pulling is said to stimulate the production of saliva.

Fennel

Due to their high concentration of flavonoids and essential oils, fennel seeds are an ideal remedy for dry mouth: They also have an antibiotic, anti-inflammatory and expectorant effect and can even help prevent bad breath. To help boost the moisture in your mouth, you can simply chew on some fennel seeds – which further stimulates saliva production – or soak the seeds in hot water and drink them as a tea.

Ginger

Ginger also has an antibacterial effect, while stimulating saliva production through its essential oils. You can either chew on a ginger root or make a soothing infusion of fresh ginger and lemon.

Drinking or gargling with lemon water

Simply mix some lemon juice with water and either drink or gargle the preparation. This increases saliva production and improves overall oral health. 

Medications for dry mouth

Adhesive tablets and lozenges  

Special dry mouth lozenges, e.g. Miradent Aquamed, are available from most pharmacies. To help keep your mouth moist throughout the day or even at night, adhesive tablets, such as Xylimelts, are an excellent choice. The tablets are simply affixed to the gums or surface of the teeth. Within a few hours they dissolve fully, delivering a continuous release of ingredients into the oral cavity. 

Sprays, gels and mouthwashes

Pharmacies also stock a range of medications for dry mouth such as sprays, gels and mouthwashes. The active ingredients include panthenol, hyaluronic acid and lactoferrin.

Pilocarpine

For patients with Sjögren’s syndrome and salivary glands that have sustained damage following radiotherapy, dry mouth is often treated with pilocarpine. 

Homoeopathy

Do you want to relieve dry mouth with homeopathic remedies? Then the best idea is to consult an alternative health practitioner to help you identify the cause and find the right treatment. Homeopathic remedies can be given in numerous ways, for example as globules, drops or pills.

Before contacting a local alternative health practitioner, you should always bear in mind that there is no scientific evidence that homeopathic treatments actually work. If symptoms improve through homeopathic remedies or practices, the cause is, according to the current state of research, most likely down to a ‘placebo effect’ – this has been discussed in publications of Helmholtz-Gemeinschaft Deutscher Forschungszentren, which bases its judgement, among other things, on two meta-studies published in the medical journals The Lancet (1997) and Systematic Reviews (2017).   

Saliva substitutes and tooth repair paste

Saliva substitutes are a particularly popular remedy for very severe cases of dry mouth. They form a film on the oral mucous membranes, thereby making swallowing and speaking less difficult. Further, in extreme cases of dry mouth, dentists recommend using a special tooth repair paste after brushing to enrich the teeth with sufficient minerals. 

What happens if dry mouth is left untreated?

Dry mouth is not only unpleasant but can also have serious consequences if you fail to treat it. 

Increased risk of dental decay and infection

If teeth and oral mucous membranes are not protected by saliva, fungi, bacteria and viruses can spread rapidly, resulting in dental decay, periodontal disease and other inflammatory conditions. This can lead to a wide variety of problems, including bad breath and tooth loss.

Digestive disorders

A lack of saliva is not just characterised by a dry mouth. Saliva plays an important role in the digestive process, breaking down carbohydrates and neutralising acids. Any disturbance to this normal process can give rise to symptoms such as heartburn.

Effects on the heart

Cardiologists have uncovered a link between periodontal disease and/or dental decay and cardiovascular diseases. In extreme cases, this can lead to a stroke or heart attack and cause inflammation of the heart muscle or clotting of the blood. 

The correct oral and dental care to treat dry mouth

Since the protective effect of saliva is not present in a dry mouth and your teeth are more exposed to decay, you should pay particular attention to good oral and dental hygiene.