• Oral care should be offered at least four times daily or as tolerated. Some patients may need more frequent care.
• Where possible, identify and manage the underlying cause, for example review medication, manage anxiety, treat intraoral infection, humidify oxygen and if appropriate encourage hydration.
• Gently remove coatings, debris and plaque from soft tissues, lips and mucosa.
• Failing to remove dried secretions, debris and plaque gently can cause pain, ulceration, bleeding and predispose to infection.
• Use damp non-fraying gauze (which has been thoroughly wetted in clean, running water) wrapped round a gloved finger to gently soak coated areas, provided it is safe to do so.
• Damp gauze (as above) or a moistened soft toothbrush can then be used to gently remove coatings and debris. The gauze should be changed when required and several pieces of gauze used to clean the mouth.
• If sponge sticks are used, they should only be used to moisten the mouth or clean the soft tissues not to remove plaque from tooth surfaces. Always check to ensure the sponge head is secure prior to use. Sponge sticks should be discarded after single use and must never be left to soak as this increases the risk of detachment and subsequent choking.
• If the patient is likely to bite down on the sponge stick, use a small headed toothbrush with soft bristles or a product with a fixed cleaning head such as “MoutheZe”.
• Encourage hydration. Cold, unsweetened drinks (such as sips of water) should be taken frequently throughout the day if possible. Sucking crushed ice or frozen tonic water may provide relief.
• Saline mouthwashes may help to clean the mouth. Patients in hospital may use 0.9% sodium chloride from a vial to be followed by rinsing with cold or warm water. For patients at home, 1 teaspoon of salt may be added to a pint of cold or warm water. A fresh supply should be made daily.
• Saline nebulisers may help with thick or crusty secretions.
• Saliva stimulation (for example sugar-free chewing gum, sugar-free boiled sweets, pastilles, mints) should be considered if the patient is able to comply.
• Saliva substitutes (for example oral gel, spray or mouth rinse) may be used if other measures are insufficient. Refer to local formulary and Chapter 12 of the British National Formulary (BNF).
• There is no strong evidence that topical therapy is effective for relieving xerostomia but many patients find them useful.
• The ideal product should be acceptable to the patient, be of neutral pH and contain electrolytes (including fluoride) to correspond approximately to the composition of saliva.
• Some preparations for dry mouth are derived from animal products and may be unsuitable for vegetarians and people from certain religious groups. AS Saliva Orthana products contain mucin of porcine origin.
• Some preparations with an acidic pH (for example Glandosane^®) should be avoided in dentate patients as long term use of an acidic product may demineralise tooth enamel.
• If a preparation without fluoride is used, a fluoride mouthwash should also be used daily in dentate patients.
• Fluoride mouthwash (0.05%) can be used at a different time from brushing.
• Topical artificial saliva and saliva stimulant products should be used as frequently as needed, including before and during meals.
• Enough artificial saliva should be used to cover the whole mouth. Applying the artificial saliva under the tongue can help to spread the artificial saliva around the whole mouth.
• Attention should also be paid to the lips. Applying a water-based product will help to prevent or treat cracked lips.
• A dry mouth can contribute to tooth decay. Where appropriate, patients should be encouraged to attend their dentist regularly for assessment and necessary treatment.