Clinical bottom line
Xerostomia and oral mucositis are common, distressing symptoms in palliative care patients, significantly impairing oral comfort, nutrition, and quality of life. Optimizing management requires a multifaceted approach including symptom assessment, hydration, saliva substitutes, topical agents, and pain control. Recent evidence supports individualized care plans emphasizing both pharmacologic and non-pharmacologic interventions, with attention to patient comfort and prevention of complications such as infection. Despite advances, challenges remain in effectively alleviating severe mucositis pain and xerostomia-related dysfunction (Weber et al., 2025; Chai et al., 2014).
What the evidence shows
Xerostomia, or subjective dry mouth, often results from salivary hypofunction due to disease or treatment effects. Hegarty et al. (2008) highlight the importance of comprehensive assessment and management strategies including saliva stimulants, substitutes, and meticulous oral hygiene to improve patient comfort.
Oral mucositis, characterized by painful mucosal ulcerations, is prevalent in oncology and palliative populations. Chai et al. (2014) describe pathophysiology and recommend topical analgesics, coating agents, and anti-inflammatory therapies to reduce pain and facilitate oral intake.
Weber et al. (2025) emphasize nursing roles in assessment and individualized interventions, including hydration support and patient education to optimize oral comfort.
Hood et al. (2020) discuss challenges in managing severe mucositis pain, particularly in patients at high aspiration risk, underscoring the need for careful analgesic selection and multidisciplinary collaboration.
Adjunctive therapies such as lactoperoxidase-containing oral care products show promise in pediatric oncology but require further validation in adult palliative care (Durmus Tanboga et al., 2013).
Symptom management guidelines (2024) advocate for integrated approaches combining pharmacologic agents, oral care protocols, and supportive measures tailored to patient needs.
Caveats and uncertainty
Evidence is limited by heterogeneous patient populations, variable definitions of xerostomia and mucositis severity, and diverse intervention protocols.
High-quality randomized controlled trials in palliative care settings are scarce.
Optimal analgesic regimens balancing efficacy and safety, especially in patients with swallowing difficulties, remain unclear.
Long-term outcomes and impact on nutrition and quality of life require further study.
How this may change practice
Routine, systematic assessment of xerostomia and mucositis should be integrated into palliative care workflows.
Individualized management plans combining saliva substitutes, topical analgesics, and supportive oral care can improve symptom control.
Enhanced nursing involvement and patient education are critical to optimize adherence and comfort.
Multidisciplinary collaboration including palliative care, dentistry, and pain specialists can address complex cases.
Research into novel agents and delivery methods may expand therapeutic options.
Clinicians should remain vigilant for complications such as secondary infections and nutritional decline.