DEAR READER: Dry mouth is a rather vague symptom and can be an indication of several disorders or side effects of certain medications or habits, such as smoking. Increased thirst can result as the body attempts to restore moisture to the mouth.

Because your letter is so short, I cannot provide a definitive answer, but based on your wording, I will give you some information about the two most likely (in my mind) candidates: Sjogren’s syndrome and diabetes insipidus.

Sjogren’s syndrome is an immune-system disorder caused by the body mistakenly attacking itself. It affects the mucous membranes and moisture-secreting glands, causing decreased production. It most commonly affects the eyes and mouth.

Risk factors include being female, over age 40, having a family history of the condition and having a rheumatic disease.

Symptoms include dry eyes and mouth, prolonged fatigue, vaginal dryness, enlarged salivary glands, persistent dry cough, skin rash, dry skin, joint pain, swelling and stiffness.

Complications of Sjogren’s include yeast infections, visual problems, dental cavities and more.

Treatment is available, but there is no cure. Mild cases can often be managed with over-the-counter eyedrops and by sipping water throughout the day to combat dry mouth. In more severe cases, prescription medications or surgery may be necessary.

Medication is available that may increase saliva and possibly tear production. An antimalarial medication has been found to be beneficial in easing symptoms of Sjogren’s. Immune-suppressing drugs such as steroids may also be used. For those with arthritis symptoms, yeast infections or other complications, medication specific to those conditions may be necessary.

When eyedrops and medications fail to improve symptoms of dry eyes, surgery to seal the tear ducts may be an option. This procedure keeps tears from draining away from the eyes, thus helping keep the eyes moist.

To help manage symptoms at home, OTC eyedrops, nasal sprays and artificial-saliva products may help. Increasing the humidity and increasing fluid intake may also be beneficial.

Diabetes insipidus (DI), despite the name, is not related to diabetes type 1 or 2. It is typically the result of the body not properly producing, storing or releasing the anti-diuretic hormone (ADH) also known as vasopressin, but it can also occur when the kidneys are unable to respond to the hormone.

The most common symptoms of DI are extreme thirst and the excretion of excessive amounts of diluted urine. Urine output can range from 2.5 liters per day for mild cases to 15 liters a day in severe cases. Normal output for healthy individuals ranges from 1.5 to 2.5 liters a day.

Diabetes insipidus is caused when the body cannot regulate its use of fluids. There are four types of DI, and each has a different way of disrupting the delicate balancing act that is involved in controlling the intake and output of fluids.

Central DI is caused by damage to the pituitary or hypothalamus gland, usually because of a tumor, illness, inflammation, surgery or a head injury. On occasion, a cause cannot be found.

Nephrogenic DI is caused by a defect in the kidney tubules, the structures that cause water to be excreted or reabsorbed. This results in the kidneys being unable to respond to ADH. The defect may be genetic or the result of a chronic kidney disorder or certain drugs.

Gestational DI occurs during pregnancy. It is caused when an enzyme made by the placenta destroys the mother’s ADH.

Finally, dipsogenic DI (primary polydipsia or psychogenic polydipsia) is caused by excessive fluid intake. When this occurs, the excess fluids suppress the ADH. This type of DI is the result of damage to the thirst-regulating mechanism within the hypothalamus, which then causes abnormal thirst. It can be the result of certain diseases, such as sarcoidosis or mental illness.

Complications of DI (excluding dipsogenic) include dehydration, dry mouth, low blood pressure, muscle weakness, weight loss, headache, fever, elevated blood sodium, rapid heart rate, sunken eyes and an electrolyte imbalance (headache, fatigue, muscle pain, irritability). Dipsogenic DI can lead to water intoxication (low blood sodium), which can cause brain damage and seizures.

Treatment depends on the severity of symptoms and the type of DI experienced. Mild cases may need only slightly increased fluid intake, while others may require medication.

Central and gestational diabetes insipidus can be treated with a synthetic hormone known as desmopressin, which acts similarly to ADH.

Nephrogenic DI cannot be treated with desmopressin, since the kidneys cannot respond appropriately because of the defect. A low-salt diet will help reduce the amount of urine made, and the medication hydrochlorothiazide (HCTZ) may be beneficial.

Dipsogenic DI has no specific treatment, since it is caused by damage to the thirst regulators and not an actual inability to regulate fluids. If mental illness is the underlying cause, treatment of the disorder may alleviate symptoms.

DEAR READER: There are a number of different Benadryl products on the market, each containing different inactive ingredients. And, as I have reported on countless occasions, all medications can carry side effects. As you have discovered, a common one in many Benadryl products is dry mouth. Furthermore, diphenhydramine/ibuprofen can cause numbness of an arm or leg and unusual joint or muscle pain.
Consider a trial without this medication. If your symptoms stop, you will have the answer. If you feel you need an antihistamine, speak with your physician regarding a substitution.

My problem now is that I don’t know where to go for relief. Nothing tastes good, not even water. Any advice you can offer will be greatly appreciated. I hope you can shed some light on my problem because so far I haven’t been able to get any answers.

DEAR READER: The citalopram you were prescribed has a number of side effects, several of which include dry mouth, nausea, arthralgias and taste perversion. To switch to another name in the same category of drugs likely continued the problem.

There are a great number of possible reasons for metallic mouth. Some of the more common causes are the use of antibiotics, medications taken for depression, heart failure, rheumatoid arthritis, kidney stones, hypertension, diabetes and calcium-carbonate supplements. Because you do not provide a medical history, I am unable to pinpoint a possible cause; however, a return visit to your physician or a specialist might be just the ticket. By ruling out conditions you do not have, you can better investigate any you are currently being treated for.

While I do not profess to know specifically why the citalopram was prescribed, you might speak with your doctor to determine whether he or she could recommend something in another class of drugs that might work for you. Or ask for an opinion on a trial of St. John’s wort, valerian, tai chi or yoga. There are several reasons why some people should not use herbs, so review your medication list with your physician before taking any action. It is also important to understand that medications are often prescribed for entirely different reasons than they were originally intended.

In the interim, maintain good oral hygiene, making sure to brush your tongue when you brush your teeth. Consider using plastic utensils for eating to see whether the metallic taste disappears.

To provide related information, I am sending you a copy of my Health Report “Vitamins and Minerals.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: There are countless causes for dry mouth. I will review a few of the more common possibilities. Medications, both over-the-counter and prescription, are often to blame. Are you on any decongestant, antihistamine, antihypertensive, anxiety or anti-diarrheal medication? Are you elderly? Do you have a history of Alzheimer’s, Parkinson’s, cancer or stroke? Do you smoke, snore or are you a mouth breather? Review my list of possibilities to determine if you fall into any of the categories. If medication might be to blame, speak with your physician regarding switching or discontinuing for a period of time. Limit your caffeine intake, discontinue any mouthwash that contains alcohol, brush your teeth with fluoride toothpaste, sip water throughout the day, chew sugar-free gum, and consider putting a humidifier in your sleeping area.

To provide related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my Web site at www.AskDrGottMD.com.

I use Hall’s Sugar Free Cough Drops because I am diabetic. Please put this tip in the paper for others to use.

DEAR READER:
Several people wrote to me regarding dry mouth and their solutions to the issue. One indicated she spoke with her dental hygienist regarding the sugar content. The reader then wrote to the manufacturer and recommended they make a sugar-free version. She received a polite note thanking her for her letter and a coupon for a free package of Tic Tacs (which wasn’t what she was looking for), but in the meantime found sugar-free Altoids work even better. The only problem is that they dissolve more rapidly than Tic Tacs. Now I have three recommendations to share with readers. Thank you for writing.

Somewhere I read that Tic-Tacs are good for this problem. When I go to bed at night, I simply place the mint between my lower gum and cheek. I don’t suck it; I just let it dissolve during the night. It seems to keep my saliva glands working and prevents my mouth my drying out at night.

I hope this may help others the way it helps me.

DEAR READER:
The Tic-Tac solution is fairly new to me. I wrote about it once, some time ago. If it works, great. My only concern is the sugar content in the mint and the possibility of cavities developing in the area (after repeated use) the Tic-Tac is placed.

Readers, let me know if you have any experience relieving dry mouth with Tic-Tacs or similar candies. I will print a follow-up column in the future.