Published: March 2013

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Medicines, Dry Mouth and Tooth Decay

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Prescriber Update 34(1):7-8
March 2013

Dry mouth (or xerostomia) is a known side effect of many different types of medicines, particularly those with antimuscarinic (anticholinergic) properties.

Healthcare professionals are encouraged to check known adverse effects in medicines data sheets or in the New Zealand Formulary (NZF) as numerous medicines have been associated with dry mouth. Medicine data sheets are available on the Medsafe website www.medsafe.govt.nz/Medicines/infoSearch.asp

A persistently dry mouth increases the risk of tooth decay, gum disease, oral infections and ulceration (particularly among denture wearers). Therefore, maintenance of good oral hygiene is very important.

Dry mouth can also cause a sticky feeling in the mouth, bad breath, mouth or throat pain, cracked lips, dry tongue, burning sensation in the mouth, angular stomatitis, and difficulties with tasting, chewing, swallowing and speaking.

Since 2000, the Centre for Adverse Reactions Monitoring (CARM) has received 227 reports of dry mouth involving 236 suspected medicines. In seven cases, associated effects of a dry mouth such as tongue or lip ulceration or toothache were reported. Of the 227 reports of dry mouth, approximately 75% were in female patients.

Levothyroxine and omeprazole were the medicines most commonly reported to CARM associated with dry mouth (Table 1).

Table 1: Top ten medicines associated with dry mouth as reported to CARM

Medicine	Number of reports
Levothyroxine	29
Omeprazole	21
Bupropion	10
Influenza Vaccine	9
Paroxetine	9
Simvastatin	7
Amitriptyline	6
Venlafaxine	6
Sibutramine	5
Varenicline	5

Management of dry mouth

If the causative medicine(s) cannot be stopped, patients should be advised to^1,2:

• take frequent sips of water (or sugarless drinks) particularly with meals to assist with chewing, swallowing and tasting.
• chew sugar-free chewing gum or suck on sugar-free lollies
• avoid caffeinated drinks, alcohol or tobacco
• use a humidifier at night
• be aware that spicy or salty foods may cause pain
• consider the use of saliva substitutes
• consider the use of a salt and bicarbonate mouth rinse².

Healthcare professionals should remind patients to maintain excellent oral hygiene including the use of a soft toothbrush with fluoride toothpaste, flossing their teeth every day and having regular dental check-ups.

References

1. Food and Drug Administration. 2011. Dry Mouth? Don't delay treatment. Consumer Updates. URL: www.fda.gov/ForConsumers/ConsumerUpdates/ucm254273.htm (accessed 12 February 2013).
2. New Zealand Dental Association. 2010. Healthy Mouth, Healthy Ageing: Oral Health Guide for Caregivers of Older People. Auckland: New Zealand Dental Association. URL: www.health.govt.nz/publication/healthy-mouth-healthy-ageing (accessed 19 February 2013).