*2.4.2 Xerostomia (dry mouth)*

If the mouth is felt to be dry, one must treat the underlining cause as is appropriate. Not all xerostomia is secondary to a decrease in salivation or dehydration.

Other causes include:


And most preferential means of palliation is to provide frequent fluids when one is able to drink, and if not, keep the mouth moistened.

Those at the end of life are vulnerable to all problems such as Candidiasis, no matter how well the mouth is cared for. It is important to check the mouth for any sore places or coatings that could indicate thrush and to treat expediently if causing the patient distress.

Saliva can be stimulated by sucking mints and candies, preferably those containing xylitol (cavity-fighting) sugar. Artificial salivas are available for purchase over-the-counter, but the effect is typically found to be no better than sipping fluids.

There is little evidence to support the use of mouthwashes, especially as they can be offensive towards the end of life; however, some individuals who have used those daily may wish to continue to do so.

Alternatives to mouthwashes, providing there is no painful thrush being treated in the mouth are as follows:


Alternatives for dry mouth which can nicely simulate "feeding" and "bonding" between caregiver and the patient who can no longer swallow or manage liquids are to swab the mouth with toothette sponges dipped into such solutions as the patient may find pleasurable. These may include such items as semi-frozen tonic water and gin, semi-frozen fruit juices, coffees or teas, cold yogurts, and small dollops of coconut oil. Having the patient suck on ice chips or small pieces of frozen pears, peaches, or berries may also be soothing. The patient would best be sitting up for this to be attempted.

If the mouth is tender and sore, a topical teething anesthetic or an oral palliative mouthwash containing equal parts of xylocaine viscous, milk of magnesia, and Benadryl maybe used before and/or after application of foods and drinks.
