Have you ever noticed your mouth turns dry when you’re in a stressful situation, like before giving a speech in public? And did you know that when you’re about to get sick from vomiting, saliva floods into your mouth? Our mouths produce saliva to chew and swallow and maintain healthy gums and teeth, but the amount and consistency of saliva can vary considerably, from clear and free-flowing to thick, stringy, sticky or foamy. If you find you regularly have foamy saliva, it’s probably a sign of dry mouth.
What Is Healthy Saliva?
Saliva is almost as unique to each person as their fingerprints. Its texture and quantity frequently change, so there isn’t one type that’s normal. However, in a healthy mouth, saliva keeps all the surfaces moist. A consistently low level of saliva can spell trouble for dental health.
According to Cathleen Terhune Alty, RDH, writing for RDH Magazine, saliva washes away food debris, reduces the growth of mouth bacteria and remineralizes tooth enamel. Without the protective effect of saliva, the mouth becomes dry and the risk of cavities and gum disease increases. What’s more, people with dry mouth can find chewing and swallowing difficult. They may also develop bad breath, mouth sores and infections.
Saliva that forms a white foam can be a sign of dry mouth. You might notice the foamy saliva at the corners of your mouth, as a coating on your tongue or elsewhere inside your mouth. Additionally, you may experience other symptoms of dry mouth, like a rough tongue, cracked lips or a dry, sticky or burning feeling.
What Causes Dry Mouth?
Dry mouth isn’t a disease by itself, but it is a symptom of many oral and whole body conditions as well as a side effect of a range of medications. Some causes of dry mouth include:
- Sjögren’s syndrome (an autoimmune disorder)
- Sinus medications
- Cancer treatment, notes Cancer Care Nova Scotia
- Diabetes medication and high blood sugar, according to the American Diabetes Association
- Cancer of the salivary glands
Sometimes, dry mouth and foamy saliva occurs only at night, due to mouth-breathing while asleep. Wearing a dental appliance or device to prevent sleep apnea at night can cause mouth-breathing, and allergies, colds, sinusitis and deformities of the nasal passage can have the same effect. If a dry mouth is due to breathing through the mouth at night, the saliva is normal during the day.
Preventing Dry Mouth and Foamy Saliva
Brushing your teeth twice a day and flossing them once a day become even more important when you have dry mouth. You should also rinse once a day with a mouthwash like Colgate Total Advanced Pro-Shield, which kills 99 percent of germs on contact with no burn of alcohol.
If you have saliva that’s regularly foamy for no reason as well as other symptoms of dry mouth, those could be signs of a serious health condition. Make an appointment with your dentist and explain your symptoms. They can work with you to find out what’s wrong, reduce your symptoms and maintain your dental health.
Dyspepsia is a common condition and usually describes a group of symptoms rather than one predominant symptom. These symptoms include:
- Belly pain or discomfort.
- Feeling uncomfortably full after eating.
- Loss of appetite.
- Burping up food or liquid (regurgitation).
Most people will experience some symptoms of dyspepsia within their lifetimes.
Common causes of dyspepsia include:
- Burped-up stomach juices and gas (regurgitation or reflux) caused by gastroesophageal reflux disease (GERD) or a hiatal hernia.
- A disorder that affects movement of food through the intestines, such as irritable bowel syndrome.
- Peptic (stomach) ulcer or duodenal ulcer.
- An inability to digest milk and dairy products (lactose intolerance).
- Gallbladder pain (biliary colic) or inflammation (cholecystitis).
- Anxiety or depression.
- Side effects of caffeine, alcohol, or medicines. Examples of medicines that may cause dyspepsia are aspirin and similar drugs, antibiotics, steroids, digoxin, and theophylline.
- Swallowed air.
- Stomach cancer.
You can make changes to your lifestyle to help relieve your symptoms of dyspepsia. Here are some things to try:
- Change your eating habits.
- It's best to eat several small meals instead of two or three large meals.
- After you eat, wait 2 to 3 hours before you lie down. Late-night snacks aren't a good idea.
- Chocolate, mint, and alcohol can make dyspepsia worse. They relax the valve between the esophagus and the stomach.
- Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make dyspepsia worse in some people. If your symptoms are worse after you eat a certain food, you may want to stop eating that food to see if your symptoms get better.
- Do not smoke or chew tobacco.
- If you get dyspepsia at night, raise the head of your bed 6 to 8 inches by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
- Do not wear tight clothing around your middle.
- Lose weight if you need to. Losing just 5 to 10 pounds can help.
Treatment depends on what is causing the problem. If no specific cause is found, treatment focuses on relieving symptoms with medicine.
Current as of: April 15, 2020
Author: Healthwise Staff
E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine
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Achalasia is a motility disorder in which the esophagus (food tube) empties slowly. The delay results from poor opening of the lower esophageal sphincter (valve) in association with the loss of the normal, orderly muscle activity (peristalsis) that propels foods and liquids along the esophagus into the stomach.
Achalasia results from the nerves in the esophagus and lower esophageal valve being damaged or destroyed. Most cases are idiopathic, meaning the cause is unknown. The origin may possibly be viral or autoimmune, and rarely it may be due to a cancer.
Men and women are equally affected. The average age of presentation is approximately 50 years, but it may also be diagnosed in children or the elderly.
Symptoms of Achalasia
The symptoms of achalasia most often occur during and after a meal. All individuals experience the sensation of solids, and usually liquids, hanging up and passing slowly into the stomach. This may occur several times a week or at every meal.
Effortless regurgitation of bland, undigested food or whitish foam (saliva) is common and may be associated with coughing and choking at night.
Some people experience chest pain, and heartburn is common. This heartburn is not related to acid reflux into the esophagus, but rather due to retained acidic food or the fermentation of food in the esophagus.
Approximately 50% of people with achalasia will lose weight.
Tests for Achalasia
The diagnosis of achalasia is suspected by barium x-rays and confirmed by esophageal manometry.
- Barium studies of the esophagus (esophagram) show a distinctive narrowing of the lower esophageal valve, esophageal dilation with retained barium in the upright position, poor esophageal emptying, and to-and-fro movement due to the loss of orderly peristalsis (coordinated wave-like muscle contractions).
- Esophageal manometry involves placing a small tube with pressure sensors into the stomach, and slowly withdrawing while measuring lower esophageal valve pressure and peristalsis. All achalasia patients have abnormal relaxation (opening) of the lower esophageal valve combined with a lack of peristalsis (orderly wave progression) in the esophageal body. Sometimes the lower esophageal valve pressure will also be abnormally high.
All achalasia patients should also have an upper GI endoscopy to exclude the uncommon case of a cancer (usually adenocarcinoma of the stomach) causing a pseudo-achalasia picture. [Endoscopy is a procedure that uses a thin, flexible tube with a light and a lens on the end to look into the esophagus and stomach.]
Treatment of Achalasia
The goal of treating achalasia is to disrupt and open the lower esophageal valve to improve esophageal emptying and relieve symptoms. Unfortunately, no treatment is available to promote the return of peristalsis.
The best treatments for healthy patients are pneumatic dilatation or laparoscopic Heller myotomy. Frail or elderly patients may do well with botulinum toxin (Botox) injections.
Treatment markedly relieves symptoms, but is rarely curative. Overall, the success of both the pneumatic dilation and heller myotomy procedures is 80%-90% and dependent on the skills of the operator. Retreatment may be required and alternative treatments may be needed.
Pneumatic dilatation – This procedure involves upper GI endoscopy with the passage of various size balloons to tear the esophagus from within, opening the valve. The procedure is done with conscious sedation and takes about 30 minutes, with a loss of one day of activity. The major complication, esophageal perforation (hole in the esophagus), is rare (less than 5%), but will require major surgery.
Heller myotomy – Surgery for achalasia involves cutting the muscle (myotomy) from the outside via small laparoscopic sites on the abdomen. The procedure requires general anesthesia, hospitalization for up to two days, and limited activity for two weeks. The major side effect is cutting the muscle too much, causing bad acid reflux.
Botulinum toxin – Botox can be injected into the esophagus and lower esophageal valve, via a needle passed through an upper endoscope. The toxin relaxes the sphincter, and thereby relieves symptoms. In young patients, symptoms relief is generally for only 3-6 months, while older patients may have relief for one year or longer. Adverse events are rare.
Medications may also be tried to relax the lower esophageal sphincter when surgery or pneumatic dilation is not an option, or Botox therapy has failed. Calcium channel blockers and long-acting nitrates are commonly used.
IFFGD has created an Achalasia questionnaire with CoRDS. To access this questionnaire, please click here
About Coordination of Rare Diseases at Stanford (CoRDS)
Based at Sanford Research, a nonprofit research institution, CoRDS is a centralized international patient registry for all rare diseases. We coordinate the advancement of research into 7,000 rare diseases. Here’s how:
-We work with patient advocacy groups, individuals and researchers.
-We capture health information from individuals with a rare diagnosis, undiagnosed patients, unaffected carriers or at-risk patients.
-We connect researchers and patients and notify our participants of emerging clinical trials.
-We make the registry accessible. Participants can enroll for free and researchers can access it for free.
-For Researchers: Access the CoRDs Registry
If you’re a researcher with IRB approval and are interested in accessing the CoRDS Registry, please contact the CoRDS team directly to complete the Access Form.
Adapted from IFFGD Publication: Achalasia – When Swallowing Becomes a Problem by Joel Richter, MD, Professor of Medicine and Hugh F. Culverhouse Chair for Esophagology, University of South Florida Health, Tampa, FL.
© Copyright 2005-2014 by the International Foundation for Functional Gastrointestinal Disorders (IFFGD)
Written for IFFGD and the American Motility Society (AMS)
Preventing Dry Mouth and Foamy Saliva
Drinking water and staying hydrated is the best way to resolve white, foamy saliva. Bring water with you, and don't wait until you're thirsty to drink it. Getting a humidifier can help keep moisture in the air, particularly if you live in a dry climate.
If you have a health condition, treating whatever is ailing you is the best way to improve saliva flow in the longterm. Still, there are immediate solutions in addition to drinking water that will help improve your saliva flow. These tips are helpful if medication is the cause of your dry mouth, too:
- Consider using an over-the-counter oral moisturizer
- Look for mouthrinses made specifically to help with dry mouth
- Sugar-free gum and lozenges can help increase saliva flow
- Ask your health professional if treatment can be adjusted to lessen potential adverse effects on your oral health
Whatever the cause of your foamy saliva, practicing good oral hygiene is always important and could improve your saliva flow. Brush at least twice a day and clean between your teeth with interdental brushes or water flossers at least once a day. Consider using other helpful products like antimicrobial mouthrinses and tongue scrapers. And be sure to see your dental professional for regular appointments – not only to keep your teeth pearly white and bacteria-free but also to check for any possible health conditions.
If you have saliva that's foamy regularly and it isn't resolved by staying hydrated, don't wait until your next cleaning to talk to your dental professional. Make an appointment right away and explain your symptoms. They can work with you to find out the cause, reduce your symptoms, and help you achieve a level of oral health you can smile about.
Burping foamy saliva
Burping up Foamy Liquid After Eating: Causes and Solutions
You’ve just finished a meal when suddenly, you feel it coming up: foamy liquid that makes you burp.
This is especially problematic when you’re in the presence of others.
There is a cause to the problem of burping up foamy or bubbly liquid after eating.
“Waterbrash – or the production of excess secretions/saliva – is a classic symptom of GERD,” says Andrew Black, MD, Diplomate of the American Board of Internal Medicine & Gastroenterology who practices with GI of Norman in Oklahoma.
GERD stands for gastroesophageal reflux disease.
Dr. Black explains, “The foam is from aerophagia: swallowing air. This ingested air mixes with the fluid and causes bubbles.
“Carbonated beverage consumption causes GERD — especially with caffeinated products. The dissolved CO2 can cause bubbles.”
So what should you do to help prevent belching up bubbly or foamy liquid after you eat?
Quite simply, do not gulp in air when you drink your beverage. Take a breath with a closed mouth before you place your lips on the rim of the glass.
Be aware of whether or not your mouth is open when you’re inhaling so that this doesn’t immediately take place before you drink from your glass.
The same goes for eating. Make sure that no air has been gulped in before the fork or spoon reaches your mouth.
You may also want to consider giving up carbonated drinks with your meals. Have water instead (but again, don’t swallow air as you drink).
Or, drink caffeine-free sodas if you can’t enjoy a meal without sodas.
But if you’re having soda with every meal, you really need to cut back, even if it’s sugar free.
Otherwise you’ll continue risking burping up that bubbly foamy stuff after eating.
Dr. Black has presented many GI-related research papers at national conferences. He is an active member of Norman Regional Hospital, and West Norman Endoscopy Center.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
What is water brash?
People with gastroesophageal reflux disease may experience a symptom called water brash. Water brash occurs when a person produces an excessive amount of saliva that mixes with stomach acids that have risen to the throat.
A person experiencing water brash can get a bad taste in their mouth and feel heartburn. Doctors sometimes refer to water brash as pyrosis idiopathica, acid brash, or hypersalivation.
Water brash is different than regurgitation — in which a mixture of stomach acids and, sometimes, undigested food comes up into the esophagus (food pipe) — due to the excessive salivation that it involves.
Keep reading to learn more about water brash, including the associated symptoms, possible causes, and treatment options.
What is water brash?
Water brash is a typical symptom of gastroesophageal reflux disease (GERD).
GERD is a common condition of the digestive system. According to experts, the prevalence of GERD is increasing in many developing countries.
GERD symptoms, including water brash, may have a significant effect on work productivity and many other aspects of day-to-day life.
In people with water brash, the salivary glands tend to produce too much saliva. The excess saliva can combine with stomach acids and cause heartburn. People describe heartburn as a burning sensation behind their chest bone. Sometimes, a person may also get a sour taste in their mouth.
Regurgitation is a more common symptom of GERD than water brash.
GERD symptoms occur because the normal mechanisms that prevent stomach acid from rising into the esophagus fail to function correctly. In many cases, this is because the lower esophageal sphincter is not working properly.
Another mechanism that can fail is the function of the phrenico-esophageal ligament. This ligament, which attaches the esophagus to the diaphragm, affects the movements of these structures during swallowing. If the ligament weakens, people can experience symptoms of GERD, including water brash.
suggests that people with GERD may produce excess saliva due to the presence of acid in the esophagus, which activates the esophagosalivary reflex.
To test this theory, researchers administered either saline solution or an acid solution into the esophagus of 15 volunteers. They noticed an increase in the production of saliva in response to the acid.
Saliva is less acidic than the contents of the stomach. Therefore, the increased production of saliva that occurs with water brash may help reduce the acidity of the stomach contents.
People can try to manage their GERD symptoms, including water brash, with over-the-counter (OTC) medications. A local pharmacist or another healthcare professional can offer them advice on the best treatment.
If the symptoms are severe or last longer than 2 weeks, a person should consult a doctor. Some people may need a referral to a gastroenterologist.
The treatment for GERD will often help provide relief from water brash. The goals when treating GERD include:
- relieving and preventing symptoms
- improving quality of life
- decreasing esophagitis, which is the inflammation of the esophagus
- preventing or treating any complications of GERD
Depending on the frequency and severity of a person’s symptoms, doctors may recommend one or a combination of the following medications:
- proton pump inhibitors
- histamine-2 receptor antagonists
Making lifestyle changes can often help relieve symptoms of GERD. These may include:
- avoiding large meals close to bedtime
- quitting smoking, if applicable
- achieving and maintaining a moderate body weight
- avoiding foods and drinks that trigger symptoms, such as spicy foods, greasy foods, and alcohol
Learn more about what to eat to prevent symptoms of GERD.
Several other home remedies can help alleviate symptoms of GERD. Read about them here.
Other symptoms of GERD
The of GERD are heartburn and stomach acids coming up into the esophagus. People sometimes describe heartburn as chest pain or burning under the breastbone.
Regurgitation is another common symptom. It occurs in of people with GERD, with its severity varying among individuals.
People describe regurgitation as a sour taste or the feeling of fluid moving up and down in the chest.
The third most common symptom of GERD is difficulty swallowing. About of people with GERD report experiencing food sticking in the chest or not going down the esophagus properly.
Other, less frequent symptoms of GERD include:
When a person experiences heartburn, they may first try managing their symptoms with OTC medications. If these remedies do not provide relief, the person should consult a doctor.
Anyone experiencing severe symptoms that affect their quality of life should seek medical attention.
People should also seek medical attention if GERD symptoms:
- last longer than 3 months with severe or nighttime heartburn
- persist after taking OTC medications, which may include antacids, histamine-2 receptor antagonists, or proton pump inhibitors
- continue when taking prescription-strength histamine-2 receptor antagonists or proton pump inhibitors
It is also advisable for someone to see a doctor if they experience:
- new onset of heartburn or regurgitation between the ages of 45 and 55 years
- blood in the vomit or stool
- anemia (iron deficiency)
- voice hoarseness, wheezing, coughing, or choking
- unexplained weight loss
- continuous nausea, vomiting, or diarrhea
It is important to be aware that the symptoms of GERD may seem almost identical to the symptoms of a heart condition. Anyone with suspected GERD symptoms who also has any of the following symptoms must seek emergency medical attention:
- chest pain radiating to the shoulder, arm, neck, or jaw
- profuse sweating
- shortness of breath
Pregnant and breastfeeding women should also speak with a doctor before taking an OTC heartburn medication.
Children under the age of 12 years should not take OTC antacids or histamine-2 receptors without their parents or caregivers taking them to see a doctor first.
People younger than 18 years should avoid taking OTC proton pump inhibitors without speaking to a doctor.
Water brash is a symptom of GERD. People with water brash produce excessive amounts of saliva. When the saliva combines with stomach acids, a person may experience heartburn and a sour taste in their mouth.
Researchers suggest that the excessive production of saliva is a result of stomach acids stimulating a reflex pathway between the esophagus and the salivary glands.
Treating GERD should resolve water brash, which can affect a person’s quality of life.
Depending on the severity and frequency of a person’s symptoms, doctors may recommend lifestyle changes or a combination of dietary changes and medications.
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Sialorrhea: a review of a vexing, often unrecognized sign of oropharyngeal and esophageal disease
Saliva is produced by the major salivary glands (parotid, submandibular, and sublingual), as well as several smaller glands. Salivary flow can be altered by multiple entities. There is much written regarding xerostomia ("dry mouth"), the condition related to inhibited or decreased salivary flow. This condition is widely recognized in certain systemic diseases, particularly Sjögren syndrome, diabetes mellitus, after anticholinergic, antihistamine, and decongestant medications, as well as states of enhanced sympathetic drive, such as anxiety or emotional disturbances and various other psychosocial conditions. On the other hand, sialorrhea or ptyalism, the condition of increased salivary flow, is rarely discussed in the clinical literature. Sialorrhea can occur with various neurologic disorders, infections, the secretory phase of the menstrual cycle, heavy metal poisoning, Wilson disease, Angelman syndrome, as well as a relatively unknown condition called idiopathic paroxysmal sialorrhea. Normal salivation may be altered by drugs (such as clozapine, risperidone, nitrazepam, lithium, and bethanecol) that have a cholinergic effect that induces sialorrhea. This report focuses on sialorrhea as it relates to disorders of the oropharynx and esophagus. The patient typically recognizes a problem with excessive "foamy mucus" but does not understand its origin. Infections and obstruction are the most common oropharyngeal causes. Increased salivary flow occurs as a typically subtle manifestation of gastroesophageal reflux disease. This occurrence is referred to as water brash. Idiopathic achalasia and megaesophagus due to the parasite Trypanosoma cruzi are regularly associated with sialorrhea. Esophageal obstruction (foreign body, cancer, or stricture formation), infection, and nasogastric intubation are the more common conditions associated with the symptomatic sequelae of sialorrhea. Sialorrhea-related respiratory and pulmonary complications are greatest in those with a diminished sensation of salivary flow and hypopharyngeal retention. Extremes of age, the chronically debilitated, or those in chronic care facilities, especially associated with cerebrovascular accidents and esophageal cancer, typically comprise this population. For the patient with an intact awareness of saliva, sialorrhea can present with significant social stigmas. Occult drooling or regular oral evacuation into a tissue or "spit cup" is socially incapacitating. This report provides a review of the physiology, pathogenesis, clinical manifestations, and therapeutic options for sialorrhea. Physicians and other healthcare professionals should recognize the importance of sialorrhea as a possible indicator or complication of a variety of disease states of the oropharynx and esophagus as well as its impact on the patient's physical and social quality of life.