Many of us with fibromyalgia (FM) also know what it is like to live with dry mucous membranes. In this article I want to review the consequences of chronic dry mouth, in particular. We will consider possible causes, its relationship to fibromyalgia, the effects on our gastrointestinal tract, and ways to manage it.
What is dry mouth?
Chronic dry mouth, xerostomia (pronounced zero-stO-mEa), is the result of insufficient saliva secretion. This is important because saliva washes away food debris, buffers digestive acids that can cause tooth decay, reduces the formation of plaque, and begins the digestive process.
In 2002 Pedersen, et al. reported “Several systemic disorders and conditions may not only be the primary cause of salivary dysfunction, they may also aggravate other conditions, thereby inducing salivary gland dysfunction.” A 2018 study, also led by Pedersen, provides insight into the mechanisms by which saliva acts as protector and how it relates to taste, chewing, formation of food blockages in the esophagus, enzymatic digestion and swallowing.
Those of us who live with fibromyalgia should be alert to all aggravating conditions and should not trivialize chronic dry mouth.
Causes of dry mouth
Many things can cause dry mouth, such as mouth breathing, poor diet, dehydration, chemotherapy and radiation, central and peripheral nerve damage that affects salivary glands, removal of salivary glands (such as seen in oral cancer), medication side-effects and/or medical conditions, like Sjögren’s, thyroid disease, diabetes, Lupus, etc. Chronic dry mouth is also one symptom of SICCA.
SICCA is collection of symptoms characterized by unusually dry eyes, mouth, throat, nose, and other mucous membranes. SICCA symptoms are commonly associated with the autoimmune disease called Sjögren’s. Some people interchange the two, and others see SICCA syndrome and Sjögren’s Syndrome quite differently. My own rheumatologist sees SICCA as Sjögren’s without the presence of tissue specific antibodies.
Herein lays the connection between dry mouth and fibromyalgia. In their 2018 study titled, Novel Sjögren’s autoantibodies found in fibromyalgia patients with sicca and/or xerostomia, Applbaum and Lichtbroun concluded:
“Approximately 1/3 of FM patients that were tested for both tissue specific autoantibodies and classic Sjögren’s markers tested positive for a Sjögren’s Syndrome biomarker, and the majority of those patients tested positive for one or more of the tissue specific autoantibodies. This suggests that autoimmunity, specifically early- stage Sjögren’s syndrome, may be involved in the pathophysiology of fibromyalgia.”
In 2005, Granot and Nagler concluded:
Oral sensory complaints, such as seen in burning mouth syndrome, may be attributed to a regional small fiber idiopathic neuropathy affecting oral sensation and salivary secretion.
Of note, small fiber neuropathy has also been implicated in fibromyalgia.
The consequences of dry mouth
Chronically thick and stringy saliva, a horse or dry throat, a tongue that is grooved or coated white, and/or sticky surfaces in the mouth suggests the presence of chronic dry mouth. This can contribute to:
- Difficulty speaking
- Difficulty chewing, swallowing, and tasting
- Insufficient digestive enzyme production
- Increased risk of bacterial and fungal infections (which can travel out of the mouth into the body’s circulation)
- Burning mouth syndrome
- Bad breath
- Mouth sores
- Dental cavities
- Gum disease
- Malabsorption of nutrients
- Gastrointestinal dysfunction
Left untreated or managed, complications related to dry mouth can affect our overall health.
Things We Can Do to Help
One of the first things I learned in nursing school was the importance of oral care. Keeping a patient’s mouth moist with glycerine swabs and treating their lips with oral moisturizers is a significant nursing intervention for a reason. Other things we can do:
- Address lifestyle issues, such as stress, diet, tobacco use.
- Consider contributing factors, such as sleep apnea or other airway obstructions (i.e. deviated septum), teeth grinding, TMJ, etc.
- Practice good oral hygiene as recommended by the American Dental Association. Brush teeth twice a day with fluoride toothpaste, clean between teeth daily, limit sugary beverages and snacks, see a dentist regularly.
- Avoid overuse of caffeine, carbonated beverages, and alcohol, which are dehydrating.
- Avoid sugar.
- Sip on water frequently.
- Rinse mouth frequently.
- Don’t use mouthwash that contains alcohol.
- Use oral lubricants and saliva substitutes.
- Suck on sugar-free hard candy or chew sugar-free gum to stimulate saliva production. (Discuss these options with your dentist.)
- Use a humidifier.
- Talk to your dentist about a mouthwash that increases saliva.
- Talk with your doctor or pharmacist about medication side effects. (i.e., antihistamines or medications used to treat fibromyalgia pain.)
- Talk with your doctor about prescription medications that can increase saliva production.
Chronic dry mouth is complicated; it’s far more than having periodic cotton mouth. And, while we may not always know what causes it, there are things we can do to minimize the effects and in the process have an effect on our overall health.
The research linked in this article is below should you wish to share this information with your physician and dentist.