Xerostomia

Xerostomia is the medical term for dry mouth. Xerostomia is usually a symptom of another underlying condition, a side effect of treatment or simply the result of not drinking enough. Xerostomia is associated with a change in the amount or thickness of the saliva someone produces. The underproduction of saliva is termed hyposalivation. 

Xerostomia may be chronic, in that it affects the individual over a period of time and as such is often related to hyposalivation (Villa et al, 2014), while acute xerostomia is likely to be related to poor fluid intake.

While the sensation of a dry mouth is subjective (Villa et al, 2014), there are some signs and symptoms which might accompany it depending on how long and how severely the person is affected, as well as the cause of the xerostomia.

Common signs of xerostomia include:

• thick tacky saliva
• halitosis
• cracked and chapped lips
• candidiasis
• tooth decay

Common symptoms of xerostomia include:

• dysgeusia (altered sense of taste)
• burning or tingling sensation in the mouth
• dysphagia (Tanasiewicz et al, 2016; British National Formulary (BNF), 2024)

The nurse should be alert to the fact that xerostomia is often a symptom of an underlying disease and as such the individual may present with a complex set of signs and symptoms of which xerostomia may be only one.

There are many different causes of xerostomia, some of which are simply related to an individual’s lifestyle such as:

• not drinking enough water
• drinking too much alcohol
• smoking and/or tobacco use
• exercise
• illicit drug use

Other causes are related to psychological or mental health conditions such as:

• stress
• anxiety
• nervousness

Causes related to physical health conditions include:

• diabetes
• oral candidiasis (thrush)
• Sjögren's syndrome (an autoimmune disease)
• Cerebrovascular accident (Millsop et al, 2017; Chaffee et al, 2021; BNF, 2024)

Xerostomia is also a side effect of some medications and medical treatments. This includes:

• chemotherapy
• radiotherapy
• prescribed medications (Vainshtein et al, 2016; Millsop et al, 2017; Barbe, 2018; Aggarwal et al, 2021)

Although there are hundreds of prescription medications which are associated with xerostomia, the ones which most commonly cause a dry mouth include diuretics, anticholinergics (eg chlorpheniramine, ipratropium bromide), sympathomimetics (eg methylphenidate) (Millsop et al, 2017; BNF, 2024). Dry mouth is

Diagnosis of xerostomia relates to the reported signs and symptoms of the individual affected. Xerostomia is a subjective experience although, there are several signs of xerostomia which patients might also present with. The signs and symptoms of dry mouth may be used to identify the underlying cause(s), which is important in identifying how to manage the condition. Taking a comprehensive and accurate patient history is an important diagnostic tool.

An inspection of the mouth of an affected individual will reveal some of the physical effects of xerostomia, which include the presence of limited amount of saliva, saliva that is thick and stringy in appearance, sore or chapped lips, mouth ulcers, stomatitis (Villa et al, 2014).

As with the management of many conditions, the removal of the cause is the primary and ideal way to manage xerostomia. For example, this could involve educating the individual about smoking cessation or increased fluid intake. After removing causes, the management of non-complicated xerostomia usually involves making some other lifestyle changes, where the nurse can advise the patient to:

• drink more liquids, especially water
• sip drinks throughout the day
• chew sugar-free gum
• limit alcohol intake
• stop smoking
• use an over-the-counter mouthwash for xerostomia (Argenio-Haines et al, 2021)

If a patient presents with xerostomia and other obvious signs of dehydration, such as tachycardia, sunken eyes or altered skin turgor, they may be dehydrated and could require rapid rehydration, a diagnosis of the underlying condition and hospital care and monitoring (NICE, 2023b). Onward referral will depend on the identified cause of the dry mouth and might include the need to refer the

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages

1.2 physical health and wellbeing

Part 2: Procedures for the planning, provision and management of person-centred nursing care

5. Use evidence-based, best practice approaches for meeting needs for care and support with nutrition and hydration, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions

Aggarwal P, Hutcheson KA, Garden AS et al. Determinants of patient-reported xerostomia among long-term oropharyngeal cancer survivors. Cancer. 2021; 127(23):4470-4480. https://doi.org/10.1002/cncr.33849 

Argenio-Haines S, Aparecida de Rezende H, Llewelyn R. Patient comfort and supporting personal hygiene. In: Lister S, Hofland J, Grafton H and Wilson C (eds). The Royal Marsden manual of clinical nursing procedures. 10th edn. Chichester: Wiley Blackwell; 2021:403-455

Barbe AG. Medication-induced xerostomia and hyposalivation in the elderly: culprits, complications, and management. Drugs Aging. 2018;35:877–885. https://doi.org/10.1007/s40266-018-0588-5 

Bauters T, Van Schandevyl G, Laureys G. Safety in the use of vaseline during oxygen therapy: the pharmacist's perspective. Int J Clin Pharm. 2016;38(5):1032-4. https://doi.org/10.1007/s11096-016-0365-7

British National Formulary (BNF). Dry Mouth. 2024. https://bnf.nice.org.uk/treatment-summaries/dry-mouth/ (accessed 6 February 2024)

Chaffee BW, Halpern-Felsher B, Cheng J. E-cigarette, cannabis and combustible tobacco use: associations with xerostomia among California adolescents. Community Dent Oral Epidemiol. 2021;10.1111/cdoe.12721. https://doi.org/10.1111/cdoe.12721 

Chandra R, Bhakta P, Beniwal J et al. Evaluation of the efficacy of transcutaneous electrical nerve stimulation (TENS) on salivary flow rate in patients with xerostomia - A case control study. J Family Med Prim Care. 2022;11(2):767-771.