Dry mouth rarely feels like thirst. Most people get used to it without noticing: a drink with dinner to get the food down, mints in the car, a glass of water at three in the morning. Your teeth notice right away. Saliva neutralizes acid, clears food away and carries minerals back into enamel, so when there isn’t enough of it, cavities keep coming back even in people who brush carefully.
The trouble is that how dry your mouth feels and how much saliva you actually make are two different things. Some people feel dry with perfectly normal flow. Others are measurably dry and feel fine, and they’re the ones who lose the most teeth to it. That’s why we’d rather look than guess, and it starts with an exam.
Six questions worth bringing to your exam
Answer these for a typical week, not a bad day.
- Do you need a drink to get dry food down, like crackers, bread, chicken or rice?
- Do you wake at night for water, or wake with your mouth open and your throat dry?
- Does your mouth feel dry while you’re eating a meal?
- Do you keep mints, gum, lozenges or hard candy going most of the day?
- Do your lips crack, or do the corners of your mouth split and stay sore?
- Do you take two or more prescription medications every day?
If you answered yes to two or more, tell us at your visit. The question about eating matters most, because a meal is when saliva should be at its highest. And the one about medications isn’t a symptom at all, but it’s the strongest predictor on the list: dry mouth is a listed side effect of more than 400 drugs, and the risk climbs with how many you take.
One more to think about, and it’s fine if you don’t know the answer: do you breathe mostly through your nose or your mouth, both during the day and while you sleep? Tell us what you think, or that you’re not sure. Mouth breathing can dry the teeth on its own, even when your saliva is normal.
Bad breath that brushing doesn’t fix can be part of the same picture, since saliva is what clears away the bacteria that cause it. It has other causes too, gum disease especially, which is one more reason to look rather than guess.
What we look at during your exam
Your answers are only part of it. At a new patient exam, Dr. Sandquist goes through your medications and your history with you, then looks at the mouth itself.
- Your X-rays. Decay along the gumline, on exposed roots, on the tips of the teeth, or around fillings that held up fine for years usually points to the mouth’s chemistry rather than to brushing. So does a set of new cavities at one checkup when nothing about your habits has changed.
- Your medications. The number matters more than any single drug. Two mild ones together can do more than one strong one.
- How you breathe. Mouth breathing dries the teeth directly, all night, however well the glands are working. It’s often the whole explanation in someone who takes no medications at all.
Then we talk through what we found and whether it points to dry mouth, something else, or nothing that needs attention.
When a saliva test makes sense
If the exam suggests your saliva may be part of the problem, we may recommend measuring it. A saliva test gives us numbers to work from instead of an impression, and it tells us whether we’re treating a real shortage or a symptom with a different cause. It looks at:
- Flow. How much saliva you make at rest, and again while chewing.
- Buffering. How well your saliva neutralizes acid. Two people can make the same amount and get very different protection from it.
- Resting pH. How acidic your mouth is between meals.
- Consistency. Thick, sticky saliva doesn’t clear food and acid the way thin, watery saliva does.
Not everyone needs it. If your answers, X-rays and history already explain what’s going on, we’ll say so.
If we do recommend it, it’s usually a separate visit rather than part of the exam. Saliva has to be measured on an empty mouth: nothing to eat or drink except plain water, no gum, no smoking and no brushing for two hours beforehand. A meal, a coffee or brushing on the way in all change the results, so we’ll book a time you can plan around and tell you exactly how to prepare. If we ever repeat the test, we’ll book it at the same time of day, because saliva changes over the course of the day and the numbers need to compare fairly.
What helps
That depends on the cause, which is why we look first. We’ll pick the two or three changes that fit you rather than handing you a list of twenty. They usually come from a short list: a humidifier in the bedroom, xylitol gum after meals, a remineralizing toothpaste last thing at night, sipping only plain water, and a baking soda rinse after meals.
If medication turns out to be part of it, please don’t stop or change anything on your own. We’ll help you work out what to ask your prescriber, and that conversation goes better with a dental finding attached to it. And if the dryness came on suddenly and is severe, especially with dry eyes, that deserves a medical workup as well as a dental one.
For the full picture of what causes dry mouth, from medications and mouth breathing to living in the desert, read Why Is My Mouth So Dry, and How Do I Fix It?
Schedule an exam
Call 702-734-0776 or tell us what’s going on, and mention dry mouth when you book. Bring your medication list with doses, including allergy pills and sleep aids. Here’s what to expect at your first visit.