Symptom: Mouth, Dry

Initial Grading Reminder

Grade 1: Symptomatic (e.g., dry or thick saliva) without significant dietary alteration; unstimulated saliva flow >0.2 mL/min
Grade 2: Moderate symptoms; oral intake alterations (e.g., copious water, other lubricants, diet limited to purees and/or soft, moist foods); unstimulated saliva 0.1 to 0.2 mL/min
Grade 3: Inability to adequately aliment orally; tube feeding or TPN indicated; unstimulated saliva <0.1 mL/min

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Have you had any issues with dry mouth in the past? Have you recently started any new medications, OTCs, supplements, or marijuana?

Grade the symptom

Ask the patient:

How dry is your mouth? Is it leading you to alter your eating/drinking habits? How much fluid are you drinking per day? Are you able to eat enough? Are you able to swallow? Have you noticed any change in how much you’re urinating?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Are you feeling weak, dizzy or confused? Are you in pain?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

  • Click Here for Telephone Triage

    Suggested Intervention

    Patients with new-onset severe (or worsening) dry mouth should be seen. Patients with any of the red-flag symptoms should be seen immediately.

  • Click Here for In-Office Triage

    Nursing Assessment of Potential Causes

    Mucositis & Xerostomia - Nursing Assessment

    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Does the patient appear uncomfortable?
    • Does the patient appear unwell?
    • Difficulty talking?
    • Licking lips to moisten often?
    • Weight loss?
    • Does the patient appear dehydrated?
    • Does the patient have thrush?
    • Does the patient report?
      • Mouth pain (tongue, gums, buccal mucosa)
      • Mouth sores
      • Difficulty eating
      • Waking during the sleep to sip water
      • Recent dental-related issues
      • Need for dental work (e.g., root canal, tooth extraction)
    • Have symptoms worsened?
    • A history of mouth sores
    • Does patient smoke?
    • Concomitant medications associated with causing dry mouth?
    • Reports of dry mouth often accompany mucositis
    • Other reports of dry membranes (e.g., eyes, nasal passages, vagina)

    Differential Diagnosis

    What do you suspect is the cause of the dry mouth?