Side Effect: Dry Mouth

Dry mouth, also called xerostomia, is a condition in which the salivary glands do not produce enough saliva to keep the mouth moist or when the saliva becomes very thick and sticky. Having a dry mouth or thick saliva increases the risk of developing cavities and mouth infections.

Symptoms of dry mouth include:

• Dried, flaky, white saliva
• Thick, sticky saliva that easily sticks to lips and other areas around the mouth
• Trouble swallowing, speaking, chewing, or tasting
• Ridged and cracked tongue due to tongue dryness
• Discomfort in and around the mouth
• Food or other material on teeth, tongue, and gums
• Feeling thirsty
• Mouth sores
• Cracks or cuts in corner of mouth or lips
• Having dentures that no longer fit leading to gum sores

Dry mouth can have many causes. Some of the causes of dry mouth in patients with cancer include:

• Immunotherapy (pembrolizumab (Keytruda®), nivolumab (Opdivo®), durvalumab (Imzinfi®), atezolizumab (Tecentriq®), etc.)
• Some chemotherapy agents
• Antihistamines (fexofenadine (Allegra®), cetirizine (Zyrtec®), loratadine (Claritin®), diphenhydramine (Benadryl®), etc.)
• Opioids (oxycodone (Roxicodone®, Percocet®), morphine (MSIR®, MSContin®, fentanyl (Duragesic®), hydromorphone (Dilaudid®), etc.)
• Diuretics (furosemide (Lasix®), bumetanide (Bumex®), torsemide (Demadex®), hydrochlorothiazide (HCTZ), etc.)
• Medications with anticholinergic properties (meclizine (Antivert®), scopolamine (Transderm Scop®), hydroxyzine (Atarax®, Vistaril®), promethazine (Phenergan®)
• Some antidepressants
• Mouth infection from fungus (candidiasis) or other microorganism
• Excessive salt intake
• Autoimmune disorders, such as scleroderma and Sjögren’s syndrome
• Dehydration
• Damage to the salivary gland from surgery or radiation therapy to the head and neck area
• Graft-versus-host disease (side effect of bone marrow transplant)

It is important to care for your mouth during cancer treatment to prevent dry mouth. The most important ways to prevent dry mouth include managing your diet, adjusting medications known to cause dry mouth, and maintaining good oral hygiene.

Food and Beverages

• Alcohol, caffeine, tobacco, hot, spicy, dry, coarse and acidic foods can cause mouth discomfort or make mouth dryness worse. These should be avoided when possible.
• Sugary foods should be avoided to prevent tooth decay and cavities.
• Chew food well and take small bites.
• Sip liquids when eating to keep mouth moist, to moisten food, and aid in swallowing. Butter, sauces, gravy, milk products and other moist liquids can also be used.
• Ice chips, sugarless hard candies and chewing gum can be used to keep mouth moist and stimulate saliva production. Citrus, cinnamon, and mint flavors often work well.
• Stay hydrated and drink plenty of fluids.

Medications

• Avoid and adjust medications known to cause dry mouth during cancer treatments when possible.

Maintain good oral hygiene

• Use a soft bristle tooth brush when brushing teeth.
• Use toothpaste with fluoride.
• If flossing, floss gently to avoid damage to the gums.
• Rinse your mouth regularly with a solution recommended by your healthcare team.
• Avoid alcohol-based mouthwashes.
• Keep lips moisturized with lip balm or other emollients.
• Consider a preventative oral health exam prior to your cancer treatment

If you develop dry mouth, it is important to still follow steps for prevention which include managing your diet, adjusting medications known to cause dry mouth when possible, and maintaining good oral hygiene. In addition to these steps, several products are available such as artificial saliva substitutes that can help moisturize the mouth and relieve dry mouth symptoms.

Prescription medications such as pilocarpine or cevimeline may be used to stimulate salivary gland function. In some cases, radiation therapy may be directed at the salivary glands to reduce inflammation and improve saliva production. Non-traditional approaches for treating dry mouth include acupuncture and transcutaneous electrical nerve stimulation (TENS). It is recommended to speak with your health care team before seeking a non-traditional method of treating dry mouth. Seeing a dentist for dry mouth may also be beneficial in some cases to prevent mouth infections and dental decay.