Psychotropic Medications and Dry Mouth

Xerostomia, commonly known as “dry mouth”, is a reported side effect of >1,800 drugrs from >80¬†classes. This condition often goes unrecognized and untreated, but it can significantly affect patients’ quality of life and cause oral and medical health problems. Although psychotropic medications are not the only offenders, they comprise a large portion of the agents that can cause dry mouth. Antidepressants, anticonvulsants, anxiolytics, antipsychotics, anticholinergics, and alpha¬†agonists can cause xerostomia. The risk of salivary hypofunction increases with polypharmacy and may be especially likely when 3 or more drugs are takenper day.

Among all reported side effects of antidepressants and antipsychotics, dry mouth often is the most prevalent. For example, in a study of 5 antidepressants 35% – 46% of patients reported dry mouth. Rates are similar in users of various antipsychotics. Patients with severe, persistent mental illness often cite side effects as the primary reason for psychotropic noncompliance. Patients may not taste food properly, experience cracked lips, or have trouble eating, oral pain, or dentures that no longer fit well. Additionally, oral diseases such as dental decay and periodontal disease, inflamed soft tissue, and candidiasis also may occur.

There are several ways for patients to manage their dry mouth symptoms. Patients should be dilligent in their oral hygiene practices, including brushing and flossing. They should use a toothpaste containing fluoride – preferrably one free of sodium lauryl sulfate – and schedule regular dental visits, where they can receive high fluoride applications or be prescribed high fluoride prescription toothpastes. Patient should avoid foods high in sucrose content, rinse their mouth with water soon after eating, and drink fluoridated water regularly. Patients may be able to stimulate saliva flow with sugarless gum, candies, and foods such as celery and carrots. Patients should also avoid cigarettes, caffeinated beverages, and mouth rinses that contain alcohol. Some patients may benefit from sleeping in a room with a cool air humidifier. Patients can also try over-the-counter salivary substitues, which are dispensed in spray bottles, rinses, swish bottles, or oral swab sticks. In addition, products such as dry mouth toothpaste and moisturizing gels also may help relieve their symptoms.

**Information obtained from Current Psychiatry, Vol. 10, No. 12