Dry Mouth (Xerostomia) is NOT a Minor Side Effect

Many health professionals categorize side effects into two buckets. There are major side effects. These are serious or life threatening. They would include things like heart attacks, strokes, liver damage, bleeding or diabetes. Then there are so-called minor side effects. This might include constipation, dizziness or dry mouth.

We actually think such adverse drug reactions are not minor because they can have a profound impact on quality of life. Dizziness can even be life threatening. If someone falls and breaks a hip it can be a death sentence. One reader wants to know about a remedy for dry mouth, also know as xerostomia in doctorspeak. Before we find out about XyliMelts, though, let’s dig deeper into dry mouth syndrome.

Dry Mouth is Serious!

Imagine what it would be like to chew up a fuzzy cotton ball after running several miles in 100-degree heat in the desert. Millions of Americans feel almost like that nearly every day, though they’re not chewing on cotton nor stranded in the Sahara.

What Causes Dry Mouth?

An astonishing number of drugs can contribute to xerostomia. This may not sound like a serious problem, and many doctors don’t think to warn patients about this side effect. But with more than 200 medications that can parch the mouth to cotton-ball dryness, xerostomia should be taken far more seriously.

At first a person might be puzzled about the dryness in his mouth, the cracking lips, the change in tongue texture. he may think the problem is thirst. It isn’t, and no amount of water slurping will dissolve the feeling that something isn’t right in his mouth.

Nasty Consequences of Dry Mouth:

If the dryness persists, it can result in physical changes to the tongue and sensitive tissues of the mouth. That, in turn, can cause difficulties in breathing, speaking and eating (International Journal of Environmental Research and Public Health, April 20, 2017).

This condition can eventually trigger a whole range of devastating dental problems, since maintenance of proper oral hygiene depends heavily on the presence of an adequate saliva supply.

Older people with dentures suffer most from dry mouth. The gums become extremely painful and may shrink so that dentures do not fit.

Perhaps the most common offenders are antihistamines and decongestants. Plenty of people get a dry mouth while they’re taking over-the-counter cold remedies or allergy medicines. “PM” pain relievers such as Advil PM, Aleve PM, Tylenol PM, etc, contain diphenhydramine. This drug has substantial anticholinergic activity that can lead to dryness of mucus membranes. Here is a list of many anticholinergic medications.

Pity the person whose prescription medicine turns his mouth into a drought disaster. Drugs like amitriptyline, atropine, clomipramine, clozapine, desipramine, dicyclomine, doxepin, fesoterodine and hydroxyzine are just a few of the many meds that can cause dry mouth. Diuretics that are prescribed to tens of millions of people with hypertension can also contribute to dry mouth syndrome. This in turn may increase the risk for dental cavities, periodontal diseases and sores in the mouth (Annals of Medical and Health Sciences Research, July, 2014).

In some cases it may be possible to stop an OTC drug with anticholinergic activity. A physician may be able to prescribe an alternate medicine that doesn’t cause dry mouth. But sometimes no substitutes can be made. Fortunately, the millions of people with this condition don’t have to simply grin and bear it. There are product that can partially take the place of missing saliva and keep the mouth moist. Sometimes, though, there is a trade off. Here is the question we mentioned at the top of this article.

Can XyliMelts Cause Diarrhea?

Q. I’m using XyliMelts at night for dry mouth and am now experiencing some diarrhea. I use one tablet per night, which contains 550 mg of xylitol. Am I overdosing? What is a safe dose to avoid this problem?

A. Sugar substitutes such as xylitol or mannitol can cause diarrhea when the dose is too large (International Journal of Dentistry, online Oct. 20, 2016).  The dose you are using is not generally considered excessive; amounts up to 10 grams of xylitol daily are considered reasonable for preventing tooth decay.

That said, people vary a lot in their tolerance for xylitol and you may be especially sensitive. In long-term trials, some people adapt to xylitol, possibly through changes in the balance of intestinal microbes.

Pets and Xylitol: A Cautionary tale!

Please keep all xylitol-containing products well out of the reach of your dogs. Xylitol is quite toxic to canines. That includes chewing gum with xylitol as well as these dry-mouth products.

Lisa in Montana shared this story:

“Xylitol is dangerous to dogs! Our grand-dog ate sugarless gum with xylitol a couple years ago, and had to be rushed to the emergency vet. Thankfully she recovered after 24 hours of treatment, and hundreds of $$, but the less than one pack that she ate would have killed her without treatment. It doesn’t take much.

“Xylitol is in many products including: some brands of toothpaste, sugarless gum, children’s vitamins, many sugar-free products including lollipops, syrups, cookie mixes, brownie mixes and jellies, Jell-o and more.”

A Simple Home Remedy:

Several years ago we received the following suggestion from a reader of our syndicated newspaper column. We have no idea if it will work, but it is inexpensive and benign.

“Here’s a home remedy for dry mouth caused by medication (not relieved by drinking water): chew on a stalk of celery. You’ll get instant relief that lasts for up to several hours.”

Another suggestion from a reader:

Linda in Morgantown, WV says:

“I switched to Tom’s of Maine toothpaste and it really helped my dry mouth. Since brushing my teeth is part of my daily routine, it’s not as onerous as using a separate product.”

Take Home Message:

It would be worthwhile to ask your physician and pharmacist what might be causing your dry mouth symptoms. If you can get to the underlying cause you may not need a saliva substitute or a dry-mouth product. If your dry mouth is caused by some other factor (such as aging or radiation) you may also want to try a saliva substitute such as Biotene, Spry, Oasis or Salivart. Let us know what has been helpful for you.