What to Do for Dry Mouth?

[tips from 15 reliable sources]

We’ve collected dry mouth (xerostomia) tips from reputable websites such as Dana-Farber Cancer Institute, BC Cancer, FDA, American Dental Association, Canadian Cancer Society etc to help you manage your dry mouth and live 10X better.

Dry mouth (xerostomia) can be caused by chemotherapy, medications, surgery or radiation therapy to the head and neck area.

Damage to the salivary glands can reduce the amount of saliva (spit) produced in your mouth making it harder to talk, taste, chew and swallow food and can lead to dental cavities, mouth infections and can interfere with your ability to maintain good nutrition.

Oral care


Oral care and dry mouth products

  • Be sure to clean your teeth Brush your teeth after each meal and at bedtime with a soft-bristle toothbrush and fluoride toothpaste. Soak the brush in warm water to make the bristles even softer. Brush the tongue gently. (Let your toothbrush air dry between brushings.)
  • Use cotton swabs, mouth swabs (popsicle stick covered with gauze) to clean teeth after each meal and at bedtime. (3 or more times a day).
  • Avoid lemon glycerin mouth swabs which also dry the mouth.
  • Rinse or spray mouth often using artificial saliva, which is sold in drugstores.
  • Floss gently with unwaxed floss once a day. You may use Water-Pik®. (Don’t floss if it causes bleeding when your platelet count is too low.)
  • Wear dentures only for meals.
  • Oralbalance® moisturizing gel can be applied to the mouth or tongue and acts as a moisturizing coat.
  • Biotene® products can be purchased without a prescription. Products available for treating dry mouth are; mouthwash, toothpaste, as well as, chewing gum that has the pH of saliva.
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Dry mouth treatment

  • See a dentist at least 2 weeks before treatment starts for an assessment of the mouth and teeth and to get any dental work done before dry mouth becomes a problem. (If you need to have teeth removed, it should be done at least 3 weeks before treatment so your mouth can heal.)
  • Talk with your dentist about solutions to replace minerals in your teet, Saliva substitutes and drugs that help your salivary glands make more saliva.
  • Fluoride treatments are important during and after radiation treatments to the head and neck area. They should be done twice daily by using soft trays that are custom made for you by your dentist.
  • If your doctor prescribes both an antibacterial rinse (Peridex) and an antifungal rinse or lozenge (nystatin), do not take them together because they will not work as well. Separate them by at least one hour.
  • Viscous Xylocaine – To prevent discomfort when eating, you may apply Viscous Xylocaine to your mouth, especially before meals. Viscous Xylocaine can be swished and spit out or it can be applied directly to a specific area with a cotton-tipped applicator. Other topical anesthetics are available at your pharmacy. Ask your doctor or nurse about specific products.
  • Pain medicine may also be used. Tylenol or stronger pain medication may help reduce oral pain. If taken half an hour before meals it may be more comfortable to eat. It is important to avoid using aspirin or non-steroidal medication (Advil, Motrin) products while on chemotherapy since they may cause bleeding problems.
  • Avoid antihistamines which can dry the area further.

Mouthwash for dry mouth

  • Rinse every two waking hours or as often as you can, especially after meals with one of the following rinses. This will help remove food particles and put a “fresh” taste in your mouth. (Different cancer treatment centers may recommend different amounts of salt or baking soda, so check with your healthcare team.)
    A – Rinse (¼ teaspoon Salt + 1 cup water)
    B – Rinse (¼ teaspoon + baking soda + 1 cup water)
    C – Rinse (¼ teaspoon glycerin + 1 cup water)
    D – Rinse (soda water)
  • If your tongue is ‘coated’, it may make your food taste unpleasant and might put you off eating. You can clean your tongue with a bicarbonate of soda solution. Use one teaspoon of bicarbonate of soda (available from your chemist) dissolved in a pint (570ml) of warm water. Clean your tongue with a soft toothbrush, foam-stick or gauze, dipped in the solution. Check with your clinical nurse specialist for more advice.
  • Avoid commercial mouthwashes and other dental products over-the-counter that contain alcohol that may burn your mouth and use products designed for people with dry mouth that are available without a prescription.

Dry lips treatment

Keep your lips from getting dry and cracking.

  • Water-based gels such as Surgi-LubeÒ, K-Y JellyÒ, Oral BalanceÒ, Mouth MoisturizerÒ can be used on the lips and the inside mouth. Water-based products must be used often, they do not stay on the lips for a long time.
  • Lanolin based lubricants If you are not prone to mouth sores you may also try lanolin-based products such as LanolelleÒ or LansinohÒ. Lanolin cannot be used if you are allergic to wool. Don’t use lanolin on the inside of the mouth and don’t use lanolin if you are using oxygen.
  • Oil-based lubricants (like mineral oil or cocoa butter) should not be used inside the mouth, they tend to be drying and cannot be used if you are using oxygen.
  • Do not use petroleum-based lubricants (like petroleum jelly or VaselineÒ) they can increase your risk of infection

Complementary therapies for dry mouth


  • Acupuncture, which some research suggests can help with dry mouth. Acupuncture may increase saliva production for people that have some naturally produced saliva.
  • Speech therapists who work on the oncology rehabilitation team can help patients with an oral hygiene regimen to address dry mouth. Specially trained in working with the mouth and throat muscles, speech pathologists may also be instrumental in teaching patients techniques on how to swallow, to increase salivary secretions, and to eat and drink without gagging or choking.

Dry mouth at night


  • Use a humidifier at night, to help moisten the air – Moisten the bedroom with a cool mist humidifier. Keep the humidifier clean using a diluted bleach solution.
  • Keep a glass of water or a “mouth wetting agent” (salivary substitutes) by your bedside and drink when you get up to use the bathroom or other times you wake up.
  • Apply prescription strength fluoride gel at bedtime unless you do not have any teeth.

Thick saliva


A dry mouth also increases the risk of infection as saliva is also very important in keeping your mouth healthy and preventing the buildup of microorganisms.
  • “Mouth wetting agents” (salivary substitutes) have occasionally provided relief for mouth dryness. Ask your doctor or dentist about medicines that increase saliva for you to try.
  • Use saliva substitute / artificial saliva product (commercially available).
  • If saliva glands are working but at low levels, these suggestions may help stimulate any saliva you have available: sugarless gum (sweetened with xylitolÒ – TridentÒ, OrbitÒ). Sugarless candy (ThayersÒ, Trident MintsÒ, SorbeesÒ).
  • Use medication if prescribed for you to help increase the saliva in your mouth. Oral pilocarpine (Salagen) is a medication approved by the FDA to stimulate saliva secretion from the remaining salivary glands. It is not appropriate for everyone with dry mouth, and it can only be obtained with a prescription from your provider.
  • Ask your oncologist about prescriptions that can help, like amifostine, which reduces the effects of dry mouth; or cevimeline, which stimulate the salivary glands.

Eating


  • Choose foods that are easier to chew and swallow. Foods like scrambled eggs, puddings, and ice cream.
  • If pills are hard to swallow, ask your doctor if it is ok to crush your pills. (Some pills do not work if they are crushed.) If it is ok, crush them up and add them to some ice cream or another soft food.
  • Dunk or soak dry foods in liquids such as herbal tea, milk, hot cocoa, soups or broth.
  • Take small bites and chew your food well.
  • Sip water or a sugarless drink during meals and take sips of fluid between bites of food. 2-3 sips of liquid with each bite of food to help “wash” food down. This will make chewing and swallow easier.
  • Sip water frequently – Carry a small bottle or spray bottle of water (or any of the above rinses) with you to help moisten your mouth during conversation.
  • Try sucking on ice chips (not chew) to help moisten and refresh your mouth or In place of ice chips, try frozen grapes.
  • Sucking on sour hard candy (sugar-free) or chewing sugarless gum (sugar-free) can help your salivary glands produce more saliva. (lemon drops, Jolly RanchersÒ).
  • Use a straw to drink thick liquids such as liquid food supplements, milkshakes, cream soups or nectars.
  • Serve food lukewarm, hot food can burn the mouth.

Dry mouth foods to eat

  • Moisten foods with sauce and gravy.
  • Increase saliva flow by eating or drinking very sweet or tart foods and beverages.
  • Add extra liquids to stews and use butter, margarine, cream, milk, broth, soup, gravy or sauces to help moisten foods and make them easier to chew and swallow. Pour sauces and gravies over vegetables, fish, chicken, meats or bread. Use extra butter and salad dressings in sandwiches and use crustless bread.
  • Use extra olive oil, sauces, broths or gravies to add extra moisture to foods.
  • Cut your food into small pieces to make it easier to chew and swallow.
  • Consume soft, bland foods. Try shakes, smoothies, fruit nectars, blenderized fruits and vegetables, very tender beef, chicken or fish and well-thinned cereals. It may help to blend foods into a puree.
  • Eat a soft, high protein moist diet – You need to eat enough protein and calories to keep your weight up. Ask your doctor about liquid food supplements that can help you meet your caloric needs and keep up your strength.
  • Try nutrition supplements like EnsureÒ, BoostÒ and Carnation Instant BreakfastÒ.
  • Add ice or skim milk to commercial nutritional supplements or milkshakes if they tend to coat the mouth or are difficult to swallow.
  • Substitute moist fish, eggs, cheese for red meat.
  • Soak bread and or rolls in milk or sauces.
  • Use sour cream, and half & half cream as sauce bases (adds calories).
  • Yogurt, fresh fruit, powdered milk
  • Fruit slushies
  • Milkshakes with or without fresh fruit.
  • Avoid sodas that are fizzy. May try letting the soda go flat and then drink.
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Food to avoid with dry mouth

  • Avoid foods that stick to the roof of your mouth, such as peanut butter, chocolate, and pastry. (Will promote tooth decay)
  • Avoid juices and liquids with a lot of sugar or that are acidic because they can contribute to tooth decay
  • Examples of foods to avoid: dried fruits, candies, chocolates, gum or mints sweetened with sugar, honey, jams, jelly, sugar coated nuts
  • Avoid dry foods like muffins, dry bread, rolls, pretzels, chips crackers and rice that break down into little pieces in the mouth.
  • Limit salty, acidic or spicy foods that can burn your mouth

Drink for dry mouth

  • Drink 8-10 cups of liquid each day – sip water, juices and other fluids frequently throughout the day.
  • Sip cool drinks in between meals to ensure adequate fluid intake.
  • Warm liquids may help to clear thick saliva and wash down your food. (Hot tea with lemon)
  • Skim or 1% MF milk-based drinks. Milk is high in protein but may produce thick saliva. If this is true for you try soy or rice milk.
  • Sugar-free or artificially sweetened lemonade or ice tea.
  • Lemonade or seltzer waters flavored with lemon or lime
  • Sports drinks
  • Diluted juices or fruit flavored beverages
  • “Diet” carbonated beverages
  • Limit drinks with caffeine such as coffee, tea, and some soft drinks. Caffeine can dry out the mouth.
  • Try OvaltineÒ and PostumÒ drinks – each has calories and vitamins – as a substitute for tea and coffee.
  • Avoid juices such as tomato, orange, grapefruit based products and sauces.

Meal and snack ideas


Breakfasts

  • Hot or cold unsweetened cereals
  • Eggs (scrambled, soft-boiled, poached, “Eggs Benedict”)
  • Soft eggs – poached, scrambled or cooked in an omelet
  • Muffin or toast dunked in a hot beverage
  • Yogurt drink or “breakfast shake”
  • Buttered toast with peanut butter or cheese
  • Cottage cheese and yogurt
  • French toast or pancakes

Light Meals

  • Soups or chowders (crackers can be broken into soup)
  • Green salads (chef’s salad, spinach salad, Caesar salad, Greek salad, marinated vegetables)
  • Egg or tuna salad, guacamole, hummus, cream cheese
  • Custard, pudding, milkshakes, smoothies
  • Pasta or potato salad
  • Fresh fruit and cottage cheese
  • Crustless sandwiches with mayonnaise-based fillings (tuna salad, ham salad)
  • Cream cheese, cucumber, and tomato sandwich
  • Ripe pears, peaches, bananas
  • Monte Cristo or French Dip sandwiches

Main Dishes

  • Stews (beef or chicken, goulash, ratatouille)
  • Pot pies or pot roasts
  • Soft main courses like soups, stews, casseroles, mild pasta, perogies or congee
  • Ground meats in casseroles (Shepherd’s pie, stroganoff)
  • Creamed salmon or seafood on toast
  • Soft vegetables like mashed potatoes, cream style corn, cooked sweet potato or squash
  • Omelet or souffle with cheese sauce
  • Canned, flaked or pureed meats or fish mixed with mayonnaise, cream soup or sauce
  • Pasta dishes with extra sauce
  • “fondue” or “hot pots” boiled or steamed vegetables with or without butter or cheese sauce
  • Rice and SauceÒ Mix

Desserts

  • Fresh fruits such as melons, grapes, pears, grapefruit
  • Canned fruits or applesauce instead of raw fruits (unsweetened)
  • Sugar-free Jell-O with or without whipped topping
  • Regular or frozen yogurt, sherbets, ice milk or ice cream
  • Mousse or fruit whip
  • Pudding or custard
  • Cheesecake with a fruit sauce
  • Creampies
  • Cake with sauce

Lifestyle changes


  • Don’t drink any type of alcohol.
  • If you do smoke, talk to your healthcare team about quitting.

References


1. Dry mouth – Canadian Cancer Society. wwwcancerca. 2018. Available at: cancer.ca. Accessed May 21, 2018.

2. Dry Mouth or Xerostomia. CancerNet. 2018. Available at: cancer.net. Accessed May 21, 2018.

3. Dry mouth – Cancer-Related Side Effect | CTCA. CancerCentercom. 2018. Available at: cancercenter.com. Accessed May 21, 2018.

4. Treating mouth problems | Cancer in general | Cancer Research UK. Cancerresearchukorg. 2018. Available at: cancerresearchuk.org. Accessed May 21, 2018.

5. Dry Mouth: A Side Effect of Treatment. Breastcancerorg. 2018. Available at: breastcancer.org. Accessed May 21, 2018.

6. If you have a sore or dry mouth – Information and support – Macmillan Cancer Support. Macmillanorguk. 2018. Available at: macmillan.org.uk. Accessed May 21, 2018.

7. Dry mouth? Sore mouth? Tips for cancer patients. Cityofhopeorg. 2018. Available at: cityofhope.org. Accessed May 21, 2018.

8. Cancer C. Dry Mouth – Managing Side Effects – Chemocare. Chemocarecom. 2018. Available at: chemocare.com. Accessed May 21, 2018.

9. Dry Mouth (Xerostomia) | OncoLink. Oncolinkorg. 2018. Available at: oncolink.org. Accessed May 21, 2018.

10. Clinics U. Dry Mouth During Cancer Treatment. University of Iowa Hospitals and Clinics. 2018. Available at: uihc.org. Accessed May 21, 2018.

11. Nutrition Tips for Managing Dry Mouth | PearlPoint Cancer Support. PearlPoint Cancer Support. 2018. Available at: pearlpoint.org. Accessed May 21, 2018.

12. Mouth care for cancer patients – Dana-Farber Cancer Institute | Boston, MA. Dana-farberorg. 2018. Available at: dana-farber.org. Accessed May 21, 2018.

13. Dental Health Before Cancer Treatment – American Dental Association. Mouthhealthyorg. 2018. Available at: mouthhealthy.org. Accessed May 21, 2018.

14. Dental Health During Cancer Treatment – American Dental Association. Mouthhealthyorg. 2018. Available at: mouthhealthy.org. Accessed May 21, 2018.

15. Dental Health After Cancer Treatment – American Dental Association. Mouthhealthyorg. 2018. Available at: mouthhealthy.org. Accessed May 21, 2018.

16. Dry Mouth? Don’t Delay Treatment. Fdagov. 2018. Available at: fda.gov. Accessed May 21, 2018.

17. Bccancerbcca. 2018. Available at: bccancer.bc.ca. Accessed May 21, 2018.