You’ve likely experienced itching and fatigue while living with primary biliary cholangitis (PBC). But have you ever noticed that your tongue turns white due to xerostomia (dry mouth)? This can be a jarring experience for people with PBC. “Anyone else get dry mouth with a white tongue sometimes?” one myPBCteam member asked.

Keep reading to explore what may be behind dry mouth and tongue discoloration if you’re living with PBC. You can also check out a few strategies to help ease these symptoms.

What Causes Dry Mouth With PBC?

Dry mouth and dry eyes are common symptoms of PBC, along with fatigue, itching, and jaundice (yellowing of the skin and whites of the eyes). But other issues besides PBC also may be causing your dry mouth.

If you’re experiencing dry mouth with PBC, it’s important to work with your healthcare provider to pinpoint the cause.

Sjögren’s Disease

The most common autoimmune disease that occurs alongside PBC is Sjögren’s disease (formerly called Sjögren’s syndrome). This condition affects about one-third of people with PBC. In Sjögren’s, your own immune system attacks the moisture-generating glands in your body, including salivary glands. This leads to dry eyes and mouth and may also cause fatigue or muscle and joint pain.

Other Liver Problems

PBC isn’t the only liver condition that may cause dry mouth. In one study of people with chronic liver diseases, 66 percent of participants experienced a reduction in saliva (spit). Less saliva can make your mouth feel dry. The study authors pointed out that this symptom may impact quality of life.

Certain Medications

The most common PBC treatments — obeticholic acid (Ocaliva) and ursodiol — aren’t known to cause dry mouth. But more than 100 other drugs do. For instance, some antidepressants can cause dry mouth. Some people with PBC experience depression, which can hurt their quality of life. One study found that 24.6 percent of participants with PBC were on antidepressants.

In addition, certain pain medications may be linked to dry mouth. Some people with PBC experience pain, so it’s important to check all side effects before taking a drug to manage pain. Depending on the one you choose, it could make dry mouth worse.

Other medications that may be linked to dry mouth include:

• Antihistamines
• Decongestants
• Antihypertensives (drugs that treat high blood pressure)
• Parkinson’s disease drugs
• Anticholinergics (drugs that treat conditions such as bladder incontinence or chronic obstructive pulmonary disorder)

Does Dry Mouth Cause White Tongue?

Although it may be jarring to see a white coating on your tongue, it usually isn’t harmful and often goes away on its own. Dry mouth and white tongue may be connected, but they may also occur independently.

Having oral dryness is one possible cause of white tongue. If you know you’ve been experiencing dry mouth, talk to your doctor or a dentist to see if that’s what’s behind your white tongue.

Other causes of white tongue include:

• Using e-cigarettes, smoking, or chewing tobacco
• Practicing poor oral hygiene (such as not brushing, flossing, or scraping your tongue)
• Injuring your tongue
• Wearing dentures
• Drinking more than one alcoholic beverage per day
• Eating too few fruits and vegetables
• Taking antibiotics
• Breathing through your mouth

Taking certain antibiotics may cause a yeast infection to form in your mouth. One type of yeast infection is oral thrush (also called candidiasis). In this condition, a fungus called Candida albicans overgrows in your mouth. It can then cause white spots to develop on your tongue.

Other conditions that may cause a white tongue include:

• Leukoplakia — Linked to heavy alcohol use or smoking
• Syphilis — A sexually transmitted infection
• Geographic tongue — Linked to arthritis, type 1 diabetes, psoriasis, and eczema
• Oral lichen planus — Caused by issues with the immune system

Managing Dry Mouth

If you’re experiencing mouth dryness, talk to your doctor about possible solutions. In some cases, treating your PBC or Sjögren’s disease may help alleviate dry mouth. Other possible solutions are listed below.

Chew Gum or Suck on Hard Candy

Sucking on hard candies and chewing gum may help increase the amount of saliva in your mouth. This can make it feel like your mouth isn’t as dry. Check the ingredients of gums and candies before you buy them. Products with xylitol, glycerin, baking soda, or aloe may be more hydrating for your mouth.

Keep Water Nearby

It’s a good idea to take small sips of water throughout the day to keep your mouth moisturized. You should also sip water in between bites of your meals. Some people choose to fill a spray bottle with water and add glycerin or aloe to it. They then spray the water into their mouth occasionally to prevent or alleviate mouth dryness.

Skip the Alcohol

Alcohol can cause dryness, so it’s best to avoid drinking it if you can. You should also ensure you aren’t using other products that contain alcohol. For instance, if you use mouthwash, make sure it’s alcohol-free.

Consider Saliva Substitutes or Other Medications

After you share information about mouth dryness with your doctor, they may recommend saliva substitutes. Many of these can be bought over the counter (OTC) to moisten your mouth.

Other OTC options include using a humidifier, a moisturizing nasal spray, or papain supplements. These contain the enzymes from papaya, which can boost saliva production.

Your gastrointestinal specialist or other provider may also prescribe pilocarpine medications to treat mouth dryness.

Adjust Your Diet

Making dietary changes may help your mouth feel less dry. For instance, caffeine can cause oral dryness, so it’s best to avoid it when possible. Add sauces, gravies, or condiments to your meals so they’re less dry. You can also consider freezing a cucumber or melon slice and then holding it in your mouth for an hour or more to keep your mouth moisturized.

Don’t Skip Dental Visits

Make sure you keep up your visits to the dentist. Dry mouth can make it easier for tooth decay to occur. Your dentist can detect any cavities, plaque buildup, or other issues early and provide medical treatment to prevent damage to your oral health.

Managing a White Tongue

If your white tongue is due to dry mouth, adding more moisture to your mouth will help improve your tongue’s color. You can also manage white tongue by employing a few other strategies.

Practice Good Oral Hygiene

Make sure you’re taking care of your teeth, gums, and tongue by using good oral hygiene habits. Use a soft toothbrush and mild fluoride toothpaste to brush your teeth. Consider using a tongue scraper or a gentle toothbrush to clean your tongue.

Avoid Irritants

Some things you put in your mouth may make white tongue worse. Smoking, vaping, and using tobacco can irritate your tongue, so it's helpful to avoid these when possible. You may also want to steer clear of foods that are very acidic, hot, spicy, or salty — as these can increase irritation.

For Infections, See a Doctor

If your white tongue stems from another condition, such as syphilis or candidiasis, see a doctor. They can treat that underlying condition with medications, which should clear up the white tongue.

Speak With Your Doctor

Always talk to your healthcare provider before trying any new supplements or medications for dry mouth. They can ensure that home remedies or over-the-counter treatments won’t put you at increased risk of PBC complications that can cause further liver damage.

Talk With Others Who Understand

On myPBCteam, the social network for people with primary biliary cholangitis and their loved ones, nearly 5,000 members come together to ask questions, give advice, and share their stories with others who understand life with primary biliary cholangitis.

Have you experienced a white tongue or mouth dryness? What solutions did you consider? Share your experience in the comments below, or start a conversation by posting on your Activities page.