• Dehydration due to fluid loss.
• Reduction in the production of saliva.
• Mouth breathing.
• For further information, see Dry mouth.

• 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

• 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

• 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

• 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