Dry Mouth (Xerostomia)

Dry mouth, also called xerostomia, can be a side effect of radiation therapy to the head and neck area or medications used to treat cancer or its side effects. Patients getting radiation to the head and neck may have a change in how saliva is made and the quality of saliva. Radiation, chemotherapy, and other medications like steroids can cause irritation that leads to more saliva being made. The saliva tends to be thicker and some patients say it feels hard to control. After treatment, the extra saliva goes away, and the mouth becomes dry. This can be a temporary side effect that may or may not go away.

Having a dry mouth may affect speech, taste, ability to swallow, and the use of dentures. Patients may say their mouths feel sore or burning. Dry mouth may also mean having cracked lips, and fissures (cracks) in the corners of the lips. Normal saliva has enzymes that protect the teeth and gums from bacteria, keeping them healthy. Having less saliva increases the risk of:

• Getting cavities.
• Periodontal disease.
• Tooth loss.

Can dry mouth be prevented?

The extent of dry mouth is based on the radiation technique used, and the dose of radiation received by the salivary glands. With these techniques, the salivary gland on the side opposite of the cancer receives a lower dose of radiation; therefore, loss of salivary function on this side may be less and may get better quicker after treatment is done.

You can also reduce your risk of getting dry mouth by avoiding certain foods like caffeine, soy products, and alcohol.

What can I do if I have a dry mouth?

If you have a dry mouth, there are things you can do to help manage it. Try these tips:

Dental Hygiene:

• Floss once a day.
• Rinse your mouth (oral cavity) right after meals.
• Dentures need to be brushed and rinsed after meals.
• Only use toothpaste with fluoride when brushing.
• Keep water handy to keep the mouth moist. Sip water or spray it in the mouth regularly.
• Use prescription-strength fluoride gel at bedtime unless you do not have any teeth.
• Rinse with salt and baking soda solution 4-6 times a day (1 tsp. salt, 1 tsp. baking soda, and 1 quart of water).
• Avoid rinses and mouthwashes that have alcohol.
• Avoid antihistamines, which can dry the area more.
• Use moisturizer often on the lips.
• See your dentist every 3 months for cleaning and dental health.

Eating Tips:

• Chew sugar-free gum/suck on sugar-free hard candy or drink diet ginger ale to stimulate saliva being made.
• Avoid liquids and foods that are high in sugar.
• Limit coffee, tea, and alcohol, as these will make your dry mouth worse.
• Avoid dry foods, like bread, dry meat, toast, crackers, and snack foods that are dry and salty.
• Add sauces or gravies to food to make it moist.

Medications and other supportive care:

• Salivary substitutes or artificial saliva preparations may relieve discomfort. They work by wetting the mouth and replacing some of what makes up your saliva.
  • Oral pilocarpine (Salagen) is a medication approved by the FDA to stimulate the making of saliva from the salivary glands. You will need a prescription for this so ask your provider if it is right for you.
  • Xylimelts® are discs that can stick to your teeth, gums, or dentures and contain xylitol and cellulose gum. They help stimulate saliva being made. 
  • Biotene® products are mouthwash, toothpaste, and chewing gum that have the pH of saliva. You can get these without a prescription.
• Use a cool-mist humidifier at night to provide humidity, mainly in winter months when the house is heated.
• Acupuncture may increase saliva production for people who still can make some saliva naturally.

Dry mouth can be a challenging side effect to deal with daily. Contact your care provider for help with managing this side effect.