Do Tobacco and E-cigarettes Cause Xerostomia?

Xerostomia is often associated with neck and head cancer treatments, injury, Sjogren’s syndrome, and several other medical conditions. Lifestyle, however, hasn’t been adequately scrutinized with respect to dry mouth. Researchers in China decided to examine the link between xerostomia and e-cigarette/combustible tobacco use. Their findings are important for public health initiatives against smoking, especially for the younger generation that is increasingly turning to e-cigarettes. 


Background: Global Prevalence of Smoking

According to the World Health Organization (WHO), nearly 1 billion people around the world suffer from health risks associated with tobacco smoking. In a 2019 National Health Interview Survey conducted by the Centers for Disease Control in the US, results suggested that 50.6 million adults in the US (more than 20%) use various tobacco products, including combustible tobacco and e-cigarettes. 


Smoking is a well-known risk factor for oral health problems, as smokers are exposed to thousands of chemicals with each puff, which alters the salivary component. 


Understanding Xerostomia

When saliva secretion decreases, all sorts of difficulties can ensue, including problems chewing, swallowing, and speaking, burning, dry, cracked, and red lips and tongue, altered taste, and increased infections and cavities. All of these symptoms unite together to create one undeniable effect: a decreased quality of life. 


One previous study showed that active smokers had higher scores for clinical oral dryness and decreased salivary flow rate. Another study that examined the link between smoking and xerostomia found a higher prevalence of xerostomia in smokers than non-smokers.

  • Of the non-smokers surveyed, 23.4% reported xerostomia
  • Of the tobacco users surveyed, 29.3% reported xerostomia
  • Of the e-cigarette users surveyed, 33.1% reported xerostomia
  • Of dual users, 28.1% reported xerostomia


Another study found that more frequent e-cigarette smokers and tobacco users reported dry mouth frequently or always, more so than non-smokers. Among e-cigarette users aged 18-years-old or younger, the prevalence of xerostomia was 31.0%. 


Understanding the relationship between smoking and xerostomia is crucial for public health. As this area of study has not been fully explored, the systemic review and meta-analysis “sought to provide an evidence-based estimation of the global prevalence of xerostomia among healthy people who used e-cigarettes and combustible tobacco.”


About the Study

“The prevalence of xerostomia among e-cigarette or combustible tobacco users: A systematic review and meta-analysis” was published in The National Library of Medicine and describes the systematic review and meta-analysis of observational studies by comparing the prevalence of xerostomia in healthy populations who smoke.


Researchers searched eight reputable electronic databases for articles published between 2000 and 2022, with combinations of keywords:

  • Dry mouth
  • Xerostomia
  • Cigarette smoking
  • Tobacco
  • Smoking
  • Electronic Nicotine Delivery Systems
  • E-cigarettes


They limited articles to those in Chinese and English, and excluded duplicates and incomplete articles. They required the following inclusion criteria: 

  • Focus on healthy people
  • Data on the prevalence of xerostomia in e-cigarette and/or combustible tobacco users
  • Observational studies


Out of 1,074 published articles, three were selected for review by two independent researchers, and any disagreements between the two were resolved by a third researcher. Out of the initial 43 articles, researchers chose 14 studies, which included a total sample size of 6,827 cases between the ages of 14 and 65. 


Study Findings

Researchers found that the overall prevalence of xerostomia was 26%. In the population of people who smoke combustible tobacco, xerostomia prevalence was 24% and in e-cigarette users it was 33%. 


They concluded that the prevalence of xerostomia is high in healthy smoking populations, and that e-cigarette users were more likely than tobacco users to have dry mouth. Additionally, dry mouth appeared more common in young smokers, which suggests that the medical community should try to generate more awareness of smoking risks in the younger generation. 


The researchers also wrote that further research in this area is required to gain a more complete understanding of the connection between smoking and dry mouth. 


They noted that one of the shortcomings of the research was that there is no uniform definition of smokers and assessment of xerostomia in all the literature they surveyed. For example, no differentiation was made between people who smoke one cigarette a day and one a month. Similarly, different studies measured the prevalence of xerostomia in different ways, with some making differentiations regarding frequency and others not. 


Dry Mouth Treatment

In healthy people who experience xerostomia, one of the first things healthcare professionals will recommend is to implement lifestyle changes: 

  • Cut out smoking, alcohol, and caffeine
  • Increase water intake
  • Sleep with a humidifier


In people with no other illnesses or injuries, these lifestyle changes should be sufficient to relieve the symptoms of dry mouth.


In cases of people with head and neck injuries, cancer, cancer treatments, metabolic disorders like diabetes and rheumatoid arthritis, and who take certain classes of drugs, a more in-depth treatment plan is usually necessary. This can include surgery, medication, and over-the-counter remedies, some of which work to increase the body’s natural production of saliva and others that work by adding artificial saliva. 


The FDA-approved SaliPen works on the former premise — it helps increase the body’s natural production of saliva by stimulating salivary glands using electro-stimulation. It activates the salivary pathways through the lingual nerve, promoting increased natural saliva production. People who suffer from dry mouth can use the SaliPen easily at home, without enduring the side effects of medication.


For more information on the SaliPen, visit our homepage or contact us here.



Is there a connection between cigarette/e-cigarette smoking and dry mouth?

Yes, studies suggest that dry mouth is more prevalent in healthy smokers than in healthy non-smokers.


Why does smoking cause dry mouth?

Smoking exposes users to thousands of chemicals with every breath, which alters the salivary components in the mouth. When saliva production is askew, dry mouth results. 


Why are studies that explore the relationship between smoking and dry mouth important?

Smoking poses a public health hazard, and any study that works to understand additional symptoms of smoking is important. This is especially true for the younger generation, who have more of a tendency to use e-cigarettes.


What is the fastest way to cure dry mouth?

If you smoke and are generally healthy but suffer from dry mouth, stop smoking and you will likely see improvement in your condition. Other habits to drop include alcohol and caffeine intake — both of these also cause dry mouth. If, however, you have medical issues IN ADDITION to smoking, you should see a medical professional.


What Dry Mouth Therapy Options Exist?

The dry mouth therapy options available to you depend on the cause of your dry mouth. If it’s from tobacco/e-cigarette smoking and you are generally healthy, you can stop smoking and see if your dry mouth symptoms are relieved. (You should also try to drink more water, use a humidifier at night, and cut down on alcohol and caffeine consumption.)


If you have health issues such as head or neck injuries, cancer, cancer treatments, metabolic disorders, or take certain types of drugs, you should make an appointment with an oral health specialist or dentist to discuss a comprehensive dry mouth treatment plan. 


The most common dry mouth treatment options include the SaliPen, prescription medications, OTC throat lozenges, mouthwashes, sprays, and gum.