Xerostomia, or dry mouth, is a common condition for adult speech therapy patients with Sjögren’s syndrome, post-head and neck cancer radiation and some chemotherapies, and other chronic issues.
Since many of our patients have more pressing needs, xerostomia can easily fall through the cracks. But if left untreated, it can result in thick saliva, dental complications, difficulties swallowing, bad breath, dry or burning tongue, mouth breathing, and even difficulty talking.
So what can we do to help?
In this post, you’ll find ideas for assessing and treating xerostomia with your adult speech therapy patients.
For ready-made dysphagia handouts and patient worksheets, check out The Adult Speech Therapy Starter Pack!
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Xerostomia Questionnaire (XQ)
The Xerostomia Questionnaire is an evidence-based patient rating scale.
Ask patients to rate each symptom on a scale from 0 to 10 (11-point scale).
You can find the full questionnaire here (table 2), but here are some sample questions:
10 = the greatest dryness or discomfort due to dryness; 0 = no dryness
- Rate your difficulty in talking due to dryness
- Rate your difficulty in swallowing solid food due to dryness
- Rate the frequency of sipping liquids for oral comfort when not eating
From the Xerostomia Questionnaire Taiwanese Version by Lin, S., et al. (2008)
Xerostomia Inventory (XI)
The Xerostomia Inventory is a reliable, easy-to-administer patient rating scale.
Ask the patient to use a 5-point scale to rate each symptom: 1 never, 2 hardly ever, 3 occasionally, 4 fairly often, 5 very often.
You can find the full inventory here (table 2), but here are some sample questions:
- My mouth feels dry
- I get up at night to drink
- My eyes feel dry
- The inside of my nose feels dry
Treating Xerostomia in Adult Speech Therapy Patients
If appropriate, refer the patient to their doctor and pharmacist to explore adding or adjusting medications that impact dry mouth. For example, antihistamines can cause xerostomia.
Use the following list to create a patient handout. Or check out The Dysphagia Pack for pre-made handouts.
Choose items based on what your patient can safely swallow:
- Stay hydrated by drinking water frequently throughout the day
- Avoid the following:
- Avoid alcohol
- Avoid smoking/tobacco
- Avoid caffeine
- Avoid hot, spicy, or acidic food (carbonated beverages)
- Avoid dry, starchy, tough foods (toast, dry cereal, crackers, tough meats, hard raw fruits or vegetables)
- Sip liquids with meals to moisten foods
- Use products with xylitol to increase saliva (e.g., Biotene®, Act®)
- Mouth spray
- Gel oral lubricants
- Mouth rinse
- Gum and melts
- Sage Toothette® Mouth Moisturizer
- Use a hydrating lip balm (e.g., Aquaphor®, Vaseline®, cocoa butter)
- Suck on ice chips or non-acidic popsicles
- Chew sugar-free gum or eat sugar-free, non-acidic hard candies
- Rinse your mouth with water or mouthwash (non-alcoholic) every 2 hours
- Use a humidifier at night
- Brush your teeth twice a day
- Floss before you go to bed
For evidence-based dysphagia handouts, therapist treatment guides, and much more, check out our shop!
- American Cancer Society. (2020). Mouth Dryness of Thick Saliva. https://www.cancer.org/cancer/managing-cancer/side-effects/eating-problems/dry-mouth.html. Retrieved May 3, 2023.
- Brewer, C.H. (2021). The Adult Speech Therapy Workbook (M. Aparo, Ed.). Harmony Road Design, LLC.
- Goyal, N., et al. (2022). Head and neck cancer survivorship consensus statement from the American Head and Neck Society. Laryngoscope Investigative Otolaryngology, 7(1), 70-92. https://doi.org/10.1002/lio2.702
- Lin, S., Jen, Y., Chang, Y., & Lin, C. (2008). Assessment of Xerostomia and Its Impact on Quality of Life in Head and Neck Cancer Patients Undergoing Radiotherapy, and Validation of the Taiwanese Version of the Xerostomia Questionnaire. Journal of Pain and Symptom Management, 36(2), 141-148. https://doi.org/10.1016/j.jpainsymman.2007.09.009
- Marek, C.L. (2023). Management of Xerostomia (Dry Mouth). University of Iowa Carver College or Medicine. https://medicine.uiowa.edu/iowaprotocols/management-xerostomia-dry-mouth. Retrieved May 3, 2023.
- Mendez, A. I., et al. (2022). Validity of functional patient-reported outcomes in head and neck oncology: A systematic review. Oral oncology, 125, 105701. https://doi.org/10.1016/j.oraloncology.2021.105701
- Memorial Sloan Kettering Cancer Center. (2023). Diet and Nutrition During Head and Neck Cancer Treatment. https://www.mskcc.org/cancer-care/patient-education/diet-and-nutrition-during-head-and-neck-cancer-treatment. Retried May 3, 2023.
- Mulligan, R. (2019). Diagnosing Xerostomia and Salivary Gland Hypofunction (SGH). Herman Ostrow School of Dentistry of USC. https://ostrowonline.usc.edu/gerodontology-salivary-gland-hypofunction/. Retrieved May 3, 2023.
- Villa, A., et al. (2014). Diagnosis and management of xerostomia and hyposalivation. Therapeutics and clinical risk management, 11, 45–51. https://doi.org/10.2147/TCRM.S76282