DRY OR PAINFUL MOUTH

Dry mouth, painful mouth and mouth ulcers are caused by infections, drugs, chemotherapy, trauma, dryness,
radiotherapy, HIV and opportunistic infections.

MANAGEMENT

Non-medicine treatment

  • Mouth wash with salted water (hourly), frequent sipping to keep mouth moist
  • Brush teeth and tongue at least 3 times a day
  • Suck fresh cold pineapple cubes once or twice daily
  • Avoid sugary foods and drinks, eat soft food
  • Apply vaseline to cracked lips
  • Review medications (dry mouth can be a side effect, e.g. of amitriptyline)

Treat appropriate infection:

  • Candidiasis with fluconazole 200 mg od for 7 days
  • Herpes simplex with oral acyclovir 200 mg, 5 times a day for 5–10 days depending on severity
  • Anaerobic gingivitis, halitosis, with metronidazole mouthwash (mix 50 mL of IV
    metronidazole with 450 mL of water, plus 50 mL of juice)

Severe mucositis or aphtous ulcers

  • Consider steroids dexamethasone 8 mg once daily for 5 days
  • Analgesic gel (Bonjela, Oracure) on ulcers

Painful mouth

  • Oral liquid morphine as above (before swallowing, hold liquid morphine in the mouth
    for at least 30 seconds)