Dry Mouth

 

Dry mouth is a side effect of some cancer treatments. It may be a direct or indirect result of treatment. Saliva is necessary for taste, swallowing, and speech. Therefore, a dry mouth can significantly impact daily activities and quality of life. Dry mouth treatment consists of symptomatic relief through stimulation of salivary flow, oral aids to decrease discomfort, or intervention with medications.

Which treatments are likely to cause a dry mouth?

The most common therapy for cancer that causes a dry mouth is radiation therapy for head and neck cancers. The radiation damages the primary salivary glands in the mouth that generate saliva and produce a “wet” feeling, reducing their production of saliva.

Mouth sores are a side effect of many chemotherapy drugs, and this condition is sometimes called mucositis. Once you have mouth sores, you may also develop symptoms of a dry mouth. Most chemotherapy drugs can cause mouth sores, but this side effect is more frequent in patients who have been treated with the chemotherapy agents listed below:

  • Alkeran® (melphalan)
  • Hydrea® (hydroxyurea)
  • Blenoxane® (bleomycin)
  • Taxol® (paclitaxel)
  • Busulfex® (busulfan)
  • Purinethol® (mercaptopurine)
  • Cytosar® (cytarabine)
  • Mustargen® (mechlorethamine)
  • Camptosar® (irinotecan)
  • Rheumatrex®,  Trexall™ (methotrexate)
  • Cosmegen® (dactinomycin)
  • Mutamycin® (mitomycin)
  • Cerubidine® (daunorubicin)
  • Navelbine® (vinorelbine)
  • Rubex® (doxorubicin)
  • Novantrone® (mitoxantrone)
  • Toposar® (etoposide)
  • Taxotere® (docetaxel)
  • FUDR® (floxuridine)
  • Thioguanine® (6-thioguanine)
  • 5-FU
  • Velban® (vinblastine)

 

What are the symptoms of a dry mouth?

Symptoms of a dry mouth are:

  • A small amount of thick or stringy saliva
  • A sore or burning feeling (especially on the tongue)
  • Changes in the surface of the tongue
  • Taste changes
  • Cracked lips
  • Cuts or cracks at the corners of the mouth
  • Changes in your ability to articulate or speak clearly
  • Difficulty wearing dentures

In addition to aiding in taste, swallowing, and speech, saliva is also important for protecting your teeth against tooth decay. Eating sugary food leaves acid in your mouth, which causes minerals to be lost from your teeth, leading to tooth decay. Saliva protects your teeth by neutralizing this acid.

Because saliva is a lubricant, it also acts to protect the cells that line your mouth. Without enough lubricant, the lining of your mouth becomes more susceptible to damage. Simply brushing your teeth or eating certain foods can damage the lining of your mouth. Once you get a small cut, it may not heal normally and can develop into a mouth sore that can be very uncomfortable and may make it difficult to eat.

What is the treatment for a dry mouth?

Treatment for a dry mouth is aimed at either relieving symptoms or preventing the damage before it happens.

Symptom Relief

Oral aids: Your doctor may recommend one of the following to relieve your dry mouth symptoms:

  • Sipping water
  • Gargling with a salt and soda mouthwash
  • Artificial saliva spray

Salagen® (pilocarpine) tablets:  The drug pilocarpine stimulates salivary flow from the minor salivary glands that are known to be rich in mucin, a component of saliva that acts as a lubricant and protects the lining of the mouth and throat. Pilocarpine appears to be moderately effective in relieving symptoms of a dry mouth. In head and neck cancer patients who received radiation therapy, patients who received pilocarpine used significantly less artificial saliva, hard candy, and water for relief of dry mouth symptoms compared with patients on a placebo. Furthermore, the patients who received pilocarpine used significantly less artificial saliva, hard candy, and water for relief of dry mouth symptoms compared with patients on a placebo. In another study, pilocarpine preserved salivary function, but patients still reported difficulties with swallowing (75 percent), activity (80 percent), hyposalivation (64 percent), and taste (81 percent).

Prevention

Ethyol® (amifostine) - Amifostine is a drug that protects against the damage of radiation. Clinical trials have demonstrated that amifostine can reduce dry mouth and may prevent mouth sores. In patients with head and neck cancer that received radiation therapy, 51 percent of patients receiving amifostine experienced a dry mouth compared with 78 percent of patients receiving radiation therapy without amifostine. One year following completion of radiation therapy, only 35 percent of patients who had received amifostine were still experiencing symptoms of a dry mouth, whereas 57 percent of patients who had received radiation therapy alone were still experiencing symptoms.  

Cryotherapy (ice chips) - Symptomatic relief from dry mouth can be achieved by sucking ice chips when the chemotherapy drug is most concentrated in the body. This technique, called cryotherapy, works by decreasing blood flow to the cells in the mouth, reducing exposure to the drug, and decreasing the risk of developing mouth sores. Furthermore, according to a recent Cochrane review, sucking ice is the only measure proven to prevent mouth sores.

What else can I do?

If you are suffering from a dry mouth, it is very important to maintain good oral hygiene to prevent infection or tooth decay. Try to maintain the following:

  • Gently brush your teeth 2 to 3 times per day. Use a soft bristle brush and warm water to prevent damaging your gums.
  • Rinse 4 to 6 times per day with a solution of salt and baking soda. Avoid mouthwashes that contain alcohol.
  • Avoid food and liquids that contain a lot of sugar. Having a dry mouth increases your susceptibility to cavities and sugar causes tooth decay.

Also, try these tips:

  • Drink plenty of water.
  • Eat moist foods with extra sauces, gravies, butter, or margarine.
  • Suck on hard candy or try chewing gum.
  • Eat frozen desserts (such as frozen grapes and ice pops) or ice chips.
  • Use a straw to drink liquids.

There are also preparations available to help treat mouth sores that are chemotherapy induced. Prescription medications include Gelclair® (glycyrrhetinic acid) and Caphosol® (artificial saliva). In addition, the coating agents Maalox and Milk of Magnesia can ease pain and help promote healing. Your doctor may also give you a slurry of Carafate® (sucralfate), which you swish and spit out, to reduce the sores. Also rinsing with topical anesthetics, such as lidocaine, xylocaine, or benzocaine, before meals can help numb your mouth.

This content was last reviewed August 15, 2010 by Dr. Reshma L. Mahtani.
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