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 and to identify the specific problem – dry mouth, candidiasis, mucositis, ulceration, or halitosis – so it can be treated directly.
| Common problem | Typical features / 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 / 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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