Clinical Presentation and Reported Symptoms

Clinical inspection of the oral cavity can include one or more of these signs: red, glossy, parched mucosal tissue, cracking in the corners of the mouth, a reddish tongue with a fissured or pebbly surface, chapped or cracked lips, or thick, foamy, ropy saliva (Figures 1A and 1B). These are objective, i.e., measurable and quantifiable observations. The palate is the driest area in the oral cavity, followed by the upper and lower lips.2 All signs and symptoms should be documented in the patient records via a written narrative and supported by extra-oral and intra-oral photographs.

Figure 1A. Drug-induced Dry Mouth.
Close-up photo of the tongue showing drug-induced dry mouth.
Image courtesy of Dr. Géza T. Terézhalmy.
Figure 1B. Drug-induced Dry Mouth.
Photo of the tongue showing drug-induced dry mouth.
Image courtesy of Dr. Géza T. Terézhalmy.

A variety of symptoms can indicate ongoing or progressing dry mouth issues. Symptoms are subjective but can be important indications of a disorder or disease or a lifestyle issue. It is common for patients to report multiple symptoms. Descriptions can be vague and are typically reported using non-medical descriptors.2,3

Classic symptoms vary by patient but include sore mucosa, a burning sensation in the mouth, complaints of stickiness, sore or dry throat, perceived reduction in saliva, hoarseness and halitosis. Patients often have trouble talking, chewing or swallowing, frequent thirst, or have an increased need to drink liquids while eating, as well as between meals. Other symptoms which point to dry mouth include feeling dry during the day, poor quality sleep, frequent urination at night, waking up with a dry mouth, difficulty in wearing dentures and performing oral hygiene activities, and a burning sensation in oral soft tissues.2,4,5,16,27,28

Dry mouth can diminish or alter the sense of taste. Those with dry mouth can report sensitivity to salty, acidic, or spicy foods.27,28 Dentinal hypersensitivity29,30 or recurrent decay can also be a primary indicator, as well as the need to chew gum or suck on candy or lozenges throughout the day. Patients with dry eyes or ocular redness may also have dry mouth issues.19