Keith is a former college basketball player and retired physical education teacher who’s still fit and active at 85 years young. When he came in last week he showed me his new bottle of medicine, Vesicare®, a drug marketed for overactive bladder. His urologist had prescribed it to him to decrease the number of times he had to get up during the night to go to the bathroom.
I asked him, “How is it working for you?”
“I was on the 5mg tablets first, but I didn’t notice any difference so the Doc upped it to the 10mg tablets.”
“Are those working better?”
“Not really. I did notice a difference at first, for the first couple days, but then it stopped working. I’m back to getting up just as often as I did before I took it.”
“Are you having any problems or side effects from it?”
“What do you mean?”
“Keith, does your mouth feel dry since you started taking it?”
“How did you know? It helps if I suck on lemon drops, though, and when I drink more water.”
Keith is not alone. It’s estimated that over 30% of people older than 65 years have some degree of dry mouth. Healthy people can make up to 1.5 liters of saliva every 24 hours, but those with dry mouth, also called xerostomia make much less. Saliva secretion can be decreased by radiation to the head and neck for cancer treatment, autoimmune diseases like Sjogren’s, rheumatoid arthritis, or lupus, or taking certain medicines chronically.
Saliva lubricates your mouth, helping you chew your food and swallow it without choking. It also dissolves some of the compounds in your food and spreads them over your taste buds to help you taste it. The moisture from your saliva also protects the lining of your mouth and teeth from injury and infection. Saliva contains very important antibacterial compounds that prevent tooth decay and gum disease.
Dry mouth like Keith was experiencing is not just a nuisance. It can be painful and costly. The lining of your mouth is more easily damaged when it is dried out. Without enough saliva to rinse them, food sticks to your teeth and tongue, dramatically increasing plaque formation and causing tooth decay and inflamed gums.
If you wear dentures, when your gums get dry they shrink and become more sensitive. The sensation of a dry mouth often triggers sipping or drinking more fluids, which in Keith’s case ended up aggravating the problem the bladder medicine was originally intended to solve. After the first couple of days on his bladder medicine, he found he made just as many nightly trips to the bathroom as before.
If you are experiencing dry mouth symptoms, what should you do?
1. Review the medications you take regularly. Are one or more of them causing your dry mouth symptoms?
The most common reason to have dry mouth is the medications you take. I call dry mouth the sneaky side effect. It can sneak up on you and create serious dental problems before you realize it. Unfortunately, every medicine marketed for bladder control causes dry mouth, some more than others. Keith drank more water to relieve his dryness, which caused him to urinate more and prevented him from getting relief from his frequent nocturnal bathroom trips.
2. Avoid chewing or smoking tobacco, because that interferes with saliva production.
3. Avoid chewing gum or sucking on hard candy sweetened by sugar.
Sugar encourages bacteria in your mouth to produce more acid, which attacks your teeth and gums. I advised Keith to switch to a sugar-free version, like xylitol. Chewing gum with xylitol may help decrease the risk of caries. Keep it out of reach of your pets, however. In dogs, xylitol triggers a very rapid rise in insulin, causing very low blood sugar and seizures, and can also cause cause liver failure.
4. If you have to take medicine that makes your mouth dry, try taking it an hour before you eat because eating stimulates saliva production.
5. Take extra good care of your teeth.
Brush and floss twice a day, using a very soft toothbrush to reduce damaging your mouth. See your dentist regularly.
6. You can try a saliva substitute, such as a spray or gel. There are also small discs that you can stick to the inside of your mouth where baseball players put chewing tobacco. Over 80% of my pharmacist colleagues recommend a Biotene® product, either the dry mouth relief spray or the clear gel called Oral Balance.
