Dry mouth from blood pressure pills: what helped, what did not, and the breath that came with it

In the spring of my sixty-second year my doctor added hydrochlorothiazide to the lisinopril I was already taking for blood pressure. It is a common combination and it brought my numbers down fine. It also, within about three months, turned my mouth into a place where crackers would not go down without a glass of water and where I woke up every morning with my tongue glued to my palate. This article is what I learned about that, in the order I learned it, with the things that helped at the top and the things that did not further down.

Why a blood pressure pill dries your mouth

Hydrochlorothiazide is a diuretic, a water pill. It makes you pass more water so there is less fluid pressing on the walls of your blood vessels. It also, as a side effect, means there is less water available for the glands that make saliva. Other blood pressure medications can do it too, and so can antidepressants, antihistamines, bladder medications, and a long list of others. The NIDCR's dry mouth page has the list, and when I read it I counted four of my six prescriptions on it.

The medical name is xerostomia, which I only mention because that is the word on the dentist's chart and the word to search if you want more than I can tell you.

Here is what I did not understand at first: saliva is not just for comfort. It washes your teeth. It neutralizes the acid that bacteria make. It carries the calcium that patches up small soft spots in enamel before they become cavities. When it goes, your teeth are suddenly undefended, and that is why Dr. Patel found two cavities on the roots of my back teeth at the next cleaning after forty years of having almost none. The ADA's page on dry mouth says the same thing in its own words: dry mouth raises the risk of decay and gum problems, and it causes bad breath.

The breath

I will say this plainly because nobody said it to me. Dry mouth gives you bad breath. Donna told me at breakfast one morning in a voice that meant she had been working up to it. The bacteria that make the smell do better when the mouth is dry, and there is no saliva to wash them away, so the smell builds up overnight and is at its worst when you wake. Mine was.

What helped, best first

Water, constantly, in small sips. This sounds too simple to be the top of the list and it is the top of the list. I bought a sixteen-ounce bottle with a flip top, kept it in my shirt pocket the way I used to keep my route card, and took a sip every time I thought about it. Not big gulps; the point is to keep the mouth wet, not to drink a gallon. Within two weeks the daytime dryness was half what it had been. Cost: the bottle, four dollars.

A humidifier in the bedroom. Donna's idea. The morning glue went down noticeably in the first week. We run it October through April when the furnace is on. Cost: thirty dollars and some distilled water.

Sugar-free gum with xylitol, after meals. Chewing makes the glands work, and xylitol is a sweetener that the decay bacteria cannot use. Dr. Patel's hygienist told me to look for xylitol as the first ingredient. Cost: about six dollars a month.

Fluoride. The hygienist started painting fluoride varnish on at every cleaning once she saw the root cavities, and Dr. Patel prescribed a high-fluoride toothpaste that I use at night. The ADA's fluoride summary explains why it matters more for a dry mouth. I have had no new cavities in three years. Cost: the prescription paste is about fifteen dollars a tube with my plan, and it lasts two months.

Talking to the doctor. I asked whether there was a blood pressure combination that would dry me out less. There was not, for me, but he did lower the diuretic dose a little and it helped some. Do not stop a blood pressure pill on your own. Ask.

What helped a little

The dry mouth rinses and sprays, the ones sold in the pharmacy aisle for this exact problem. They coat the mouth and feel good for an hour or so. I used them for a year and still keep a spray by the bed. They are a comfort, not a fix.

Dry mouth lozenges, the ones that dissolve slowly. Same as the rinses: good for an afternoon, no lasting change.

What did not help

Regular mouthwash, the kind with alcohol. It made things worse, and the hygienist told me why: alcohol dries the mouth. I had been using it twice a day for the breath. I stopped and the mornings were better within days.

Breath mints with sugar. Sugar in a dry mouth is about the worst thing you can do for your teeth. I did not know and I ate a lot of them.

The probiotic, and what I think of it

By the end of year two I had the dryness mostly under control with water and the humidifier, and the breath was better, but the mornings still had a sour edge that Donna could tell me about and that I could taste myself. My granddaughter, who is a nurse, sent me a link and said some people her age were trying oral probiotics for exactly that. I thought it sounded like one more thing to sell an old man.

I read what I could find. The NCCIH's page on probiotics is the government's plain summary, and it says the evidence for most uses is early and that they are generally safe for healthy adults. That was enough for me to try it, since it was sixty dollars and not six hundred.

I ordered three bottles of the ProDentim chewable. One tablet a morning, chewed slowly after coffee, no water for a half hour afterward, which is harder than it sounds when you have a bottle in your pocket. The first month, nothing I could swear to. The second month, Donna said the mornings were better before I had said anything, and I had noticed the sour taste was mostly gone. That has held for about a year now. I keep ordering it.

What it did not do: it did not make my mouth less dry. Nothing in a bottle does that. It did not fix my gums or whiten anything. It handled the morning breath that was left after the water and the humidifier had done the heavy work. If your mouth is still bone dry, I would do the water and the humidifier first, because I tried the tablet for a week in year one, before all that, and it did nothing I could tell.

My routine now

Morning: water, coffee, the probiotic tablet, then brush with the prescription paste about an hour later. Day: sips from the pocket bottle, xylitol gum after lunch. Night: brush with the prescription paste, spit and do not rinse, humidifier on. Dentist every four months instead of six, because of the dry mouth, which my plan covers two of and I pay for the third.

I am not cured of anything. I am managed, which at sixty-eight is what you hope for. If you are on a water pill and your mouth has gone dry, start with the bottle in the pocket. Then the humidifier. Then, if the mornings are still sour, ProDentim's site lists what is in the tablet and what it costs, and you can decide for yourself. Give it two months if you try it. The first one does not count.