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Dry mouth Assessment Questionnaire

Questions Your Doctor May Ask - and Why!

During a consultation, your doctor will use various techniques to assess the symptom: Dry mouth. These will include a physical examination and possibly diagnostic tests. (Note: A physical exam is always done, diagnostic tests may or may not be performed depending on the suspected condition) Your doctor will ask several questions when assessing your condition. It is important to openly share any pertinent information to help your doctor make an accurate diagnosis.

It is also very important to bring an up-to-date list of all of your all medical conditions, medications including dosages, and names of numbers of any specialist you see.

Create your printable checklist by answering questions that your doctor may ask below:

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  1. How long have you had the dry mouth (xerostomia)?

    Why: to establish if acute or chronic.

  2. What is the age of the person with dry eyes?

    Why: elderly people often complain of a dry mouth as salivary secretion tends to fall with age.

  3. Are there simple reasons for the dry mouth?

    Why: e.g. stuffy nose, mouth breathing, snoring, stage fright, fear, anxiety.

  4. Fluid intake?

    Why: may suggest inadequate intake of fluid and dehydration as cause of dry mouth e.g. poor fluid intake due to illness, anorexia, malnutrition or neglect.

  5. Have you been treated with radiation therapy?

    Why: may cause dry mouth if the head and neck has been exposed to radiation.

  6. Past medical history?

    Why: e.g. Rheumatoid arthritis, systemic lupus erythematosus, primary biliary cirrhosis, diabetes insipidus, Raynaud's phenomenon, systemic sclerosis, chronic active hepatitis and vasculitis may all be associated with Sjogren's syndrome; Diabetes mellitus, diabetes insipidus, hyperparathyroidism, kidney failure, hypercalcaemia can all cause excessive urination, dehydration and thus dry mouth; Vitamin A deficiency and dry mouth may occur in people with liver disease, intestinal sprue, after intestinal bypass and if receiving total parenteral nutrition.

  7. Medications?

    Why: e.g. antihistamines, some diuretics, some high blood pressure medications, some muscle spasm medications, certain decongestants, tricyclic antidepressants, anticholinergics medications and tranquilizer medications may cause dry mouth.

  8. Illicit drug use?

    Why: e.g. amphetamine intoxication and marijuana may cause dry eyes.

  9. Dietary history?

    Why: nutritional deficiency states may cause dry mouth such as Vitamin B2 and Vitamin A deficiency; dietary deficiency of Vitamin A is often due to failure to incorporate green leafy vegetables into the diet usually exclusively in developing countries may cause night blindness and dry eyes; Botulism food poisoning from preserved anaerobic food.

  10. Symptoms of dehydration ?

    Why: e.g. thirst, postural dizziness, fainting and reduced urine output - may cause dry mouth.

  11. Symptoms of Primary Sjogren's syndrome?

    Why: e.g. dry eyes, dryness of the mouth, skin or vagina. This syndrome may be associated with many systemic conditions such as Raynaud's phenomenon, difficulty in swallowing (as seen in systemic sclerosis), painful joints (like that seen with systemic lupus erythematosus), thyroid disease, myasthenia gravis, primary biliary cirrhosis, chronic active hepatitis, renal diabetes insipidus, renal tubular acidosis and vasculitis.

  12. Symptoms of Rheumatoid arthritis?

    Why: e.g. joint pain, swelling, deformity and morning stiffness. It may also cause a number of systemic symptoms including carpal tunnel syndrome, anemia and enlarged spleen. 15% of people with Rheumatoid arthritis have a secondary Sjogren's syndrome which comprises dry eyes and dry mouth.

  13. Symptoms of diabetes mellitus

    Why: e.g. frequent urination, excessive thirst, weight loss, fatigue - dry mouth may be present in uncontrolled or undiagnosed diabetes mellitus due to excessive urination.

  14. Symptoms that may cause dehydration?

    Why: e.g. vomiting, diarrhea, fever, excessive urination, extensive exfoliation of skin, gastrointestinal bleeding.

  15. Symptoms of salivary gland obstruction due to stones?

    Why: e.g. painful swelling of the salivary gland after eating.

  16. Neurological symptoms?

    Why: e.g. double vision, blurred vision, sensitivity of the eyes to light, poor coordination, difficulty with speaking and dry mouth - may suggest botulism caused by the neurotoxin of clostridium botulinum which flourishes in preserved anaerobic food.

  17. Symptoms of primary biliary cirrhosis?

    Why: e.g. itchy skin, jaundiced (yellowing) skin.

  18. Symptoms of Raynaud's phenomenon?

    Why: e.g. sequential discoloration of the digits from pallor to blueness to redness upon exposure to cold. When fingers become red they are painful. Raynaud's phenomenon may be associated with Sjogren's syndrome.

Conditions listing medical symptoms: Dry mouth:

The following list of conditions have 'Dry mouth' or similar listed as a symptom in our database. This computer-generated list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.

Select from the following alphabetical view of conditions which include a symptom of Dry mouth or choose View All.

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Conditions listing medical complications: Dry mouth:

The following list of medical conditions have 'Dry mouth' or similar listed as a medical complication in our database.


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