CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Palliative cancer care - oral problems - Management
View full scenario
What are the causes of dry mouth?
- Dehydration due to fluid loss.
- Reduction in the production of saliva.
- Mouth breathing.
- For further information, see Dry mouth.
What assessment do I need to make?
- Perform a full history and examination. Assess concurrent symptoms, psychological state, social needs, and spiritual needs. See the CKS topic on Palliative cancer care - general issues.
- Assess the person's:
- Understanding of the diagnosis and their current problems, and how they and their family/carer are coping.
- Nutritional status and whether their fluid intake is adequate.
- Level of oral hygiene, and whether they can carry out routine oral care.
- Estimate the likely prognosis, if possible. For further information, see Prognostic Indicator Guidance (pdf).
In depth
How should the underlying causes of dry mouth be managed?
- Treat any of the following underlying causes of dry mouth if appropriate:
- Adverse effect of a drug being taken. Reduce the dose or change the drug if possible.
- Dehydration. This should be reversed except in the terminal phase.
- Anxiety. This becomes increasingly common towards the end of life and should be managed appropriately.
- Candida infection. See Oral Candida infection.
- If on oxygen consider humidification of this.
In depth
How should symptoms of a dry mouth be relieved?
- Try simple saliva stimulatory measures first, as these will often relieve symptoms of dry mouth (even if rehydration is not undertaken):
- Cold unsweetened drinks, frequent sips or sprays of cold water or ice cubes/crushed ice/ice lollies.
- Rubbing petroleum jelly (e.g. Vaseline®) on the lips. However, if a person is on oxygen apply a water-soluble lubricant (e.g. K-Y Jelly®).
- Sugar-free chewing gum, boiled sweets, pastilles, mints.
- If symptom relief is not adequate, consider using:
- A topical saliva stimulant.
- A topical artificial saliva substitute.
- Pilocarpine tablets.
- In people with their own teeth, the use of acidic foods (e.g. pineapple) or acidic artificial saliva products (e.g. Glandosane® aerosol spray) should generally be avoided.
- Note: patient preference is likely to influence product acceptability and compliance.
In depth
When should I refer or seek specialist advice?
- Refer or seek specialist advice if in doubt about the diagnosis or management of any oral problem.
- Refer if any of the following are present:
- Oral problems that are causing a decrease in oral intake or concerns about nutrition.
- Severe oral herpes simplex infection as intravenous administration of aciclovir may be needed.
- Severe mucositis. It can be extremely painful and may limit future chemotherapy or radiotherapy.
- Suspected neutropenic ulcers and neutropenia. Seek urgent medical advice.
- Severe or persistent Candida infection.
- Oral ulcers that are bleeding.
- Taste disturbance that is likely to be prolonged. Refer to a dietitian where appropriate.
- Pain that is difficult to manage.
- Communication problems. Refer to a speech and language therapist where appropriate.
In depth
Prescriptions
Topical saliva stimulants
Age from 16 years onwards
Salivix pastilles: When required to relieve dry mouth.
Salivix pastilles
Suck one pastille when required to relieve dry mouth.
Supply 50 pastilles.
SST tablets: When required to relieve dry mouth.
SST saliva stimulating tablets
Slowly dissolve one tablet in the mouth when required to relieve dry mouth.
Supply 100 tablets.
Topical artificial saliva sprays
Age from 16 years onwards
AS Saliva Orthana: When required to relieve dry mouth.
AS Saliva Orthana spray
Spray 2 or 3 times into the mouth when required to relieve dry mouth.
Supply 50 ml.
Glandosane spray: When required to relieve dry mouth.
Glandosane synthetic saliva spray lemon
Spray into the mouth when required to relieve dry mouth.
Supply 50 ml.
Saliveze spray: When required to relieve dry mouth.
Saliveze mouth spray
Spray into the mouth when required to relieve dry mouth.
Supply 50 ml.
Xerotin spray: when required to relieve dry mouth.
Xerotin spray
Spray into the mouth when required to relieve dry mouth.
Supply 100 ml.
Topical artificial saliva products except sprays
Age from 16 years onwards
AS Saliva Orthana Lozenges: use when required to relieve dry mouth
AS Saliva Orthana lozenges
Suck one lozenge when required to relieve dry mouth.
Supply 30 lozenges.
Biotene Oralbalance: use when required to relieve dry mouth
Biotene Oralbalance dry mouth saliva replacement gel
Apply to the gums and tongue when required to relieve dry mouth.
Supply 50 grams.
BioXtra spray: use when required to relieve dry mouth
BioXtra Gel Mouthspray
Spray into the mouth when required to relieve dry mouth.
Supply 50 ml.
Salinum liquid: use when required to relieve dry mouth
Salinum liquid
Rinse the mouth with 2ml and then swallow, when required to relieve dry mouth.
Supply 300 ml.
Pilocarpine tablets
Age from 16 years onwards
Pilocarpine 5mg tablets: take one three times a day
Pilocarpine 5mg tablets
Take one tablet three times a day (to relieve dry mouth). Always take the last tablet each day with the evening meal.
Supply 84 tablets.
© NHS Institute for Innovation and Improvement