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
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?
Ask the patient:
Are you feeling weak, dizzy or confused? Are you in pain?
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?
Patients with new-onset severe (or worsening) dry mouth should be seen. Patients with any of the red-flag symptoms should be seen immediately.
What do you suspect is the cause of the dry mouth?