What is Dry Mouth (Xerostomia)?
Learn What Dry Mouth Is & How to Manage It
The term “dry mouth” is used to describe reduced saliva production or the subjective feeling of having a dry mouth (xerostomia). Up to 90% of survivors experience this as a side effect of head and neck cancer treatments. Dry mouth may occur because the salivary glands don’t make enough saliva due to surgery or radiation (called salivary gland hypofunction), or because the mouth feels dry even when saliva production is normal. Dry mouth can begin during treatment and may last for weeks, months, or even permanently for some people.
Why Saliva is Important
Saliva plays a key role in:
- Eating– Breaks down food for easier chewing & swallowing.
- Speaking – Keeps the mouth moist for clear, comfortable speech.
- Oral Health – Washes away bacteria and food, protects teeth from cavities, and prevents infections — in severe cases, when combined with radiation- can contribute to jawbone infections (osteoradionecrosis).
Without enough saliva, you might have:
- A constant dry feeling in the mouth.
- Thick, stringy, or discolored saliva (brown or yellow).
- A burning feeling in your mouth or tongue.
- Trouble chewing and swallowing, especially dry foods.
- Changes in taste, making food less enjoyable.
- More cavities, gum disease, and mouth infections (like thrush).
- Difficulty speaking.
- Changes in the sound of your voice (hoarseness).
- Trouble wearing dentures.
- Sleep problems (head and neck cancer patients may be at higher risk for sleep apnea).
- Emotional distress.
Why it matters:
Dry mouth isn’t just uncomfortable —it affects your eating, speech, and overall oral health. Managing dry mouth is important for comfort, nutrition, and preventing serious dental problems.
What Causes Xerostomia?
The most common cause of dry mouth in head and neck cancer survivors is radiation therapy. While radiation kills cancer cells, it can also damage the salivary glands, reducing saliva—sometimes permanently.
- Salivary glands are very sensitive to radiation, even at low doses.
- Both major glands (like the parotid and submandibular glands) and minor salivary glands in the mouth and throat can be affected.
Other contributing factors:
- Chemotherapy – Some drugs can dry out your mouth.
- Medications – Other prescriptions (e.g., painkillers, antidepressants, anticholinergics) may worsen dry mouth.
- Dehydration – A common side effect of cancer treatments that can make symptoms worse.
Because many things can cause dry mouth, managing it requires a comprehensive approach that considers all possible causes, including other medications, diet and habits, or other health problems.
How Might Dry Mouth Affect Me?
People suffering from dry mouth can experience a number of things, including:
- You might need to drink more water, especially while eating.
- You may find it hard to chew or swallow dry foods.
- You might discover that that food and drink taste different.
- Your saliva may become thickened or discolored (brown or yellow).
- You can experience changes in the sound of your voice.
- It may become difficult to wear dentures.
- You may experience oral yeast (candida) infections.
- You may have problems with your oral health, including tooth sensitivity, cavities, bleeding, or infections. Dry mouth puts you at increased risk for rapidly progressive tooth damage, dental abscess, gum inflammation, and gum disease. Dental disease may lead to tooth loss and damage of the jaw bone.
How Can I Manage Dry Mouth?
The goal is to ease symptoms by:
- Boosting Natural Saliva Production – Encouraging the salivary glands to produce more saliva if they still have some function.
- Using Moisturizing Products – Moisturizing products or artificial saliva, such as sprays or gels, to keep the mouth moist.
Whenever possible, stimulating natural saliva should be the first choice. Saliva relieves dryness, helps fight bacteria and protects oral health—something artificial products can’t fully replace.
Before you begin treatment:
✔ See your dentist – Fix any existing issues and keep your mouth healthy.
✔ Use fluoride – Applied by your dentist and daily at home with a mouth guard to prevent cavities and damage.
✔ Check your medications and diet – Some meds and foods (like salty foods and fizzy drinks) can make dry mouth worse. Talk to your doctor about changes that may help.
During treatment:
Some treatments aim to protect the salivary glands during radiation therapy, but results have been mixed. These include:
✔ Newer radiation methods (like intensity-modulated radiation therapy)
✔ Medications (such as amifostine, pilocarpine, or bethanechol) taken before or during treatment
✔ Surgery (moving a salivary gland to avoid radiation damage)
✔ Acupuncture
✔ Other methods listed below
While some of these treatments may help, the evidence isn’t strong enough to guarantee prevention of dry mouth.
After treatment:
✔ Saliva Boosters – Sugar-free lozenges, gum, or medications like pilocarpine and cevimeline may help your remaining glands make saliva.
✔ Moisturizers & Substitutes – Artificial saliva sprays, gels, or lozenges can help keep the mouth hydrated.
✔ Electrostimulation (TENS) & Acupuncture – These might help some people, but more research is needed.
Easy Self-Care Tips for Managing Dry Mouth
Download our strategy guide and list of common medications for dry mouth
Drink water often
- Sip water all day long – don’t wait until you’re thirsty.
- Carry a water bottle and take small sips often.
- Try a spray bottle for quick hydration on the go.
- Add flavor! Cucumber, mint, or berries can make water taste better.
Eat smart
- Choose soft, moist foods (yogurt, oatmeal, soup).
- Add sauces, gravies, or broths to meals.
- Dip dry foods (bread, crackers) in liquid.
- Avoid salty, spicy, crunchy, or acidic foods (chips, citrus, tomato sauces).
- Limit alcohol and caffeine—they dry your mouth.
- Consider rubbing a little olive or sunflower oil on your gums before eating.
Take care of your mouth
- Brush after meals and before bed with a soft-bristled toothbrush.
- Use fluoride toothpaste.
- Rinse with alcohol-free mouthwash or a baking soda + water mix.
- See your dentist every 3-4 months.
- Use fluoride trays or fluoridated water.
- Use a wax- or lanolin-based lip balm (not petroleum-based).
For those at high risk for cavities
- Ask your dentist for a “re-mineralizing product,” such as a calcium or phosphate paste or toothpaste.
- An antimicrobial rinse may also be added.
- Follow a diet that does not promote cavities—such as limiting sugar and avoiding sugary drinks.
Boost saliva production
- Chew sugar-free gum or suck on hard candies (citrus, cinnamon, or mint).
- Suck on ice cubes or sugar-free popsicles.
- Use saliva sprays, gels, mouthwashes to keep your mouth moist. Look for products with xylitol in them.
- Use a humidifier at night.
Simple changes can make a big difference! Try a few and see what works best for you.
