GPAtlas🧭 When to suspect
Suspect oral problems in any palliative patient, particularly those reporting dryness, soreness, pain, or difficulty eating or swallowing.
Oral symptoms are common, under-recognised, and a major cause of distress. They impair eating, drinking, talking and dignity, and frequently lead to refusal of food, fluids and medication.
Useful clues include halitosis (bad breath), taste change, visible ulcers, a coated tongue, or drooling.
Common risk factors are opioids, anticholinergics, diuretics, steroids, oxygen therapy, dehydration, chemotherapy or head/neck radiotherapy, and frailty limiting self-care.
The twin clinical tasks are to:
• Relieve symptoms with daily mouth care.
• Identify the specific problem – dry mouth, candidiasis, mucositis, ulceration, or halitosis – so it can be treated directly.
| Common problem | Typical features and cause |
|---|---|
| Xerostomia (dry mouth) | • Glazed, dry mucosa • Difficulty speaking and swallowing • Opioids, anticholinergics, diuretics, oxygen, dehydration, radiotherapy |
| Oral candidiasis (thrush) | • White plaques that wipe off to leave a red base, or sore erythematous mucosa and angular cheilitis • Steroids, antibiotics, dentures, dry mouth, immunosuppression |
| Mucositis | • Diffuse erythema, ulceration and severe pain • Chemotherapy or head/neck radiotherapy |
| Painful ulcers | • Aphthous, herpetic, or malignant • Trauma, infection, or tumour |
| Halitosis | Malodour from poor hygiene, infection, stasis, or an anaerobic/fungating tumour. |
| Coated tongue or altered saliva | • White or brown coating • Thick, ropey secretions or drooling • Poor clearance, dehydration, reduced swallow |
Source: Scottish Palliative Care Guidelines
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