Table 12

Investigation and management of a dry mouth

InvestigationsPotential resultsClinical management plan
Actions from history, medication and dietary assessment
History findingsCancer related
  •  ▸ Tumour infiltration

  •  ▸ Paraneoplastic syndrome

  • Cancer treatment related:

  •  ▸ Irradiation to the head and neck/salivary glands

  •  ▸ Iodine-131

  •  ▸ Surgery

  •  ▸ Chemotherapy

  •  ▸ Biological treatment (interleukin 2)

  •  ▸ Graft vs host disease

General advice Oral hygiene: refer to dentist/oral hygienist. Use fluoridated toothpaste—all dentate patients should use toothpaste with at least 1000 ppm fluoride, while dentate patients with radiation-induced salivary gland dysfunction should use specialist toothpaste with 5000 ppm fluoride. Limit acidic and sugary drinks/foods/medication and rinse mouth after these products.Symptomatic management4
  1. Consider saliva substitutes, eg, artificial saliva spray or lozenges (mucin based) or a non-porcine alternative, if required for cultural reasons.

Note: Glandosane spray, Salivix pastilles and SST tablets are acidic products and may demineralise tooth enamel.
  • 2. Consider mechanical salivary stimulants:

  •  ▸ Sugarless chewing gum/mints.

  •  ▸ Pilocarpine 5 mg three times a day in patients treated with radiotherapy to the head and neck.

  • Consider referral for acupuncture.5

Oral infectionTreat according to local guidelines.
Inadequate fluid intake/dehydrationEncourage oral fluid intake and oral hygiene.
Decreased mastication (liquid/soft diet)Refer for dietetic assessment and advice. Refer to a speech and language therapist.
Diabetes mellitus6Refer to a GP.
Sjögren's syndromeRefer to the rheumatology team.
Medication findings4Antidepressants:
  •  ▸ SSRI's

  •  ▸ Tricyclic antidepressants

  • Ace inhibitors

  • Antiemetics

  • Antihypertensives

  • Antimuscarinics

  • Antipsychotics

  • Calcium antagonists

  • Opioids

Many other medications can cause dry mouth. Check, if any doubt, using an Electronic Medicines Compendium7.
First line
If no improvementPsychological issuesRefer for psychological support.
Missed organic causeRefer to oral surgery.
  • GP, general practitioner; SSRI, selective serotonin reuptake inhibitor; SST, saliva stimulating tablet.