Dry Mouth: A Greater Risk When You Have Arthritis

Sjogren’s syndrome, medications and aging are all factors.


Everyone has a dry mouth now and then – from nerves, stress, too much exercise or too little water. But if your dry mouth doesn’t go away – no matter how much H2O you drink – the problem may lie with your salivary glands.

Chronic dry mouth (xerostomia) occurs when your salivary glands don’t produce enough saliva to keep your mouth moist. Your lips and the skin around them may dry and crack, too, and you might find it hard to talk or swallow.

What Causes It?

Lots of things can contribute to a chronically dry mouth, but medications are the main culprit. More than 500 prescription and over-the-counter (OTC) drugs affect how your salivary glands work. Among them: antihistamines, antidepressants, antipsychotics, blood pressure pills, diuretics, pain relievers and sedatives. If your mouth feels like it’s permanently stuffed with cotton, start by checking the side effects of your medications or ask your doctor about them.

Aging also plays a role; many older adults produce less saliva, not necessarily as a result of age, but because they may take a lot of medications and have chronic health problems.

Drugs and aging are the most common causes of dry mouth. But if you have rheumatoid arthritis (RA) or lupus, you’re also at increased risk of Sjogren’s syndrome, an autoimmune disorder whose main symptoms are dry mouth and eyes.

For years, Sjogren’s was considered a nuisance condition that didn’t cause serious problems. It’s now known that it can also affect your joints, kidneys, lungs, skin and cause ongoing fatigue. Like other autoimmune diseases, Sjogren’s occurs when inflammation’s directed against the body’s own tissues – in this case, the glands that produce moisture in your mouth and eyes.

There are two types of Sjogren’s syndrome – primary and secondary. The secondary form is diagnosed when someone who already has another autoimmune disease, such as RA or lupus, develops Sjogren’s symptoms. Dry mouth symptoms tend to be worse in primary Sjogren’s.

What’s So Bad about Dry Mouth?

Dry mouth is uncomfortable and can present daily challenges, including the inability to taste or enjoy food. More important, it affects your oral health and digestion. Saliva contains antibacterial compounds that prevent tooth decay, gum disease and bad breath. It also makes chewing and swallowing easier and contains the enzyme amylase, which helps break down starches.

“Operating a mouth with no spit is like driving a car without motor oil,” explains Anna Diaz-Arnold, DDS, a professor in the Department of Family Dentistry at the University of Iowa.

A Healthier Mouth

The goal of treatment is to keep your mouth as moist as possible. Most therapies are simple things you can do yourself, like taking small sips of water throughout the day, chewing sugar-free gum and investing in a room humidifier.

Many people also find saliva substitutes helpful. These come as sprays, gels and lozenges and are sold online and in most pharmacies. Some contain xylitol, which can help protect against cavities but may also cause stomach upset. You might want to stick with products made from carboxymethylcellulose or hydroxyethylcellulose. Your dentist can probably suggest a good brand.

In addition to taking steps to keep your mouth moist, the American Academy of Oral Medicine recommends avoiding sugary foods and candies to lower the risk of cavities and limiting caffeine, which makes dry mouth worse.

Two medications are approved to stimulate saliva production in people with Sjogren’s or salivary gland damage from cancer treatment: cevimeline HCL (Evoxac) and pilocarpine (Salagen). These medications are usually only tried if nothing else has worked. Both have side effects and interact with a host of other drugs, including blood pressure pills, so talk to your doctor about the risks and benefits.

Also, discuss your dry mouth with your dentist. You may need more-frequent cleanings and examinations. Your dentist may also suggest anti-cavity toothpaste and other products to help keep your mouth healthy.