Mouth Problems and Swallowing Difficulties
For information on Mouth Problems and Swallowing Difficulties, please select one of the topics below.
Any problem with your mouth can affect eating and drinking as well as your ability to talk comfortably. Some of the common causes of mouth problems include:
- Certain medicines that cause a dry mouth.
- Radiotherapy treatment to the head and neck area, which can cause a dry and sore mouth.
- Some drugs that can cause painful mouth ulcers.
- Infections of the mouth, lips and throat - particularly oral thrush.
Mouth care routine
Following a regular mouth care routine can help prevent or lessen mouth problems:
- Brush your teeth and gums every morning and evening using a small, soft-bristled toothbrush and fluoride toothpaste.
- Provided it isn’t sore, gently brush your tongue when cleaning your teeth.
- Use water or an alcohol-free mouthwash to rinse your mouth after meals. You can do this more often if needed. You can make a mouthwash by dissolving one teaspoon of bicarbonate of soda in 600mls (1 pint) of boiled then cooled water.
- Rinse your dentures after meals.
- Remove your dentures at night. Clean them with a toothbrush and toothpaste or denture paste. Soak them overnight in a denture solution containing sodium hypochlorite (for example 1tsp of Milton® in 400ml water), but if your dentures have metal parts use chlorhexidine solution instead. Rinse dentures well before use.
- If your doctor prescribes a mouthwash for you, use it regularly as prescribed.
- Gently use dental tape or floss daily.
- Keep your lips moist by using Vaseline® or a flavoured lip balm.
- A pen torch and mirror can be helpful for inspecting inside your mouth.
Some people with advanced illness have a dry mouth, because they produce less saliva or they breathe more through their mouth due to breathlessness. Oxygen treatment can also cause a dry mouth. Radiotherapy to the head and neck and certain drugs can be another cause. Speak to your doctor if it’s likely that a drug is causing your dry mouth, as a replacement drug may be available. Feeling anxious can also make your mouth feel dry. A dry mouth can be uncomfortable and change the way your food tastes.
Tips for dealing with a dry mouth
- Regular mouthwashes can help keep your mouth clean and moist, but avoid any that contain alcohol or glycerine as these can dry the lining of your mouth. If your tongue is coated, try gently cleaning it with a soft toothbrush or cotton bud.
- Fizzy drinks such as fresh orange juice with soda water can be a refreshing way to keep your mouth moist. You could also try sucking flavoured ice cubes and ice lollies.
- Keep your lips moist by using Vaseline® or a flavoured lip balm. Smoothing a small amount of vegetable oil on the lining of your mouth can help to keep it moist, especially at night.
- Artificial saliva is available as gels, sprays, pastilles or lozenges. Your doctor can prescribe these for you.
Food hints that may help if you have a dry mouth
- Have a drink with meals.
- Avoid dry foods and include plenty of sauces and gravy with meals.
- Sugar-free chewing gum can stimulate saliva production.
- Eat foods with a high fluid content, such as jelly, pureed fruits and soft puddings.
- Unsweetened pineapple chunks or melon can help keep your mouth fresh and moist.
- Avoid chocolate and pastry as they can stick to the roof of your mouth.
If you have a dry mouth for a long time you have a higher risk of tooth decay, so it’s important to take care of your teeth. Your dentist will be able to help you with this and will want you to have regular check-ups. Some dentists will visit you at home if you can’t attend the surgery.
Sore mouth and throat
Many drugs can make your mouth sore and cause mouth ulcers. If you have radiotherapy to your mouth and/or throat, you can have the same problem. You may also develop a sore mouth if you:
- Aren’t able to eat a nutritious diet
- Have a low immunity
- Have an infection of the lining of your mouth or throat.
If you have mouth ulcers, your doctor may prescribe an antiseptic and painkilling mouthwash for you to use. You may also be prescribed a protective gel that can help ease any pain and discomfort. If you’re taking antibiotics or steroids, you may develop a fungal infection in your mouth called thrush. This coats your tongue and can make eating unpleasant. Your doctor can prescribe an anti-fungal medicine to clear this. If your mouth or lips become sore, see your doctor who can check for signs of infection or thrush. If you do have an infection, the doctor can prescribe treatment. If, after taking a course of anti-fungal medicine for thrush, your symptoms haven’t improved, it’s important to go back to your doctor to try a different type of anti-fungal medicine. Always contact your doctor if mouth pain is making it difficult to eat or talk. They can prescribe painkillers if necessary.
Helpful hints if you have a sore mouth
- Follow a mouth care routine as far as possible.
- If your toothpaste stings, use a mouthwash instead.
- If you wear dentures, you may find it easier to leave them out for a while to prevent them rubbing against your gums. Ask your doctor about this if you’re having radiotherapy to the jaw area, as you may be advised to keep your dentures in as much as possible during the day to help maintain the shape of your gums.
- Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty foods, as these may irritate your mouth.
- Keep your mouth and food moist. Add gravy and sauces to your food to make swallowing easier.
- Avoid rough-textured food, such as toast and crisps, as these can scrape sore areas.
- Try to drink at least one litre (about two pints) of fluid a day - this can include water, tea, weak coffee and soft drinks such as fruit juices.
- Try drinking through a straw to avoid irritating sore parts of your mouth.
- Cold foods and drinks can be soothing to a sore mouth. Try adding crushed ice to drinks and eating ice cream or ice lollies.
- Warm herbal teas may be more soothing than acidic drinks like orange and grapefruit juice.
Drooling (or dribbling) is the unintentional loss of saliva from the mouth. Drooling beyond infancy may occur in some medical conditions such as when there is inflammation of the mucous membranes of the mouth or as a reaction to some medications, which can increase the amount of saliva produced. In some conditions including motor neurone disease, Parkinson’s disease and multiple sclerosis, drooling is usually related to:
- Abnormalities in swallowing (rather than to absence of swallowing)
- Difficulties moving saliva to the back of the throat
- Poor mouth closure
- Jaw instability
- Tongue thrusting
Drooling is not usually caused by having too much saliva as you might think. Instead it has been found that there is a tendency to swallow less frequently than normal. Drooling can be made worse by a lack of head control and poor posture, lack of sensation around the mouth, breathing through the mouth, excitement and impaired concentration. There can be health and hygiene problems for people who drool most of the time and excessively. The skin around the mouth, chin and neck can become red and sore, and dehydration may occur because of fluid loss. There may also be problems with eating, infections may be more easily transmitted and choking is more likely, as are chest infections.
Treatments for drooling
A variety of techniques have been used to treat drooling. Treatments may include:
- Surgery, where salivary glands are usually turned towards the back of the mouth so that saliva runs towards the back rather than the front of the mouth
- Exercises to increase muscle tone, improve oral-motor function and improve sensory awareness
- Medication, where drugs might be used to dry up salivary secretions
- Botulinum toxin injections to help prevent and control drooling
- Removal of a salivary gland may be considered in extreme cases
Difficulty swallowing (dysphagia)
Swallowing is a complicated reflex action that we usually take for granted. Difficulty swallowing, sometimes called dysphagia, may be caused by many things and can cause distress to some people living with a terminal illness. It is important to tell your doctor if you have any difficulty swallowing and you may be referred to a speech therapist or dietician in your area.
Heartburn is a burning sensation behind the breastbone that can be very painful. It’s caused by the backflow of acid from the stomach into the gullet (oesophagus) and can be set off by certain foods and medicines. It can be made worse by lying flat or wearing tight clothing around the waist. Tips to prevent heartburn
- Avoid large meals, chocolate, alcohol, fatty foods, fizzy drinks, chewing gum, hard-boiled sweets, mint, aniseed and dill.
- Wear loose clothing around your waist.
- Try not to lie flat on your back, especially after meals.
Drug treatments can also help relieve troublesome heartburn. Your GP can prescribe these for you.
This is discomfort in the upper part of the tummy (abdomen), occurring particularly after meals. It can be caused by:
- Having a small stomach capacity
- Irritation of the stomach or bowel lining caused by some drugs (such as steroids)
- Overproduction of stomach acid
- Not moving around much
- Not eating or drinking much.
Hiccups are a sudden contraction or spasm of the diaphragm (the breathing muscle under the lungs). They’re a reflex action, so they aren’t under your control. Mild hiccups are common. They usually last for only a few minutes and don’t need to be treated. However, if you have hiccups that keep coming back or that last for more than two days, you may need treatment. When hiccups last for a long time it can be distressing and uncomfortable. It can also make eating, drinking and sleeping difficult.
Hiccups can be caused by:
- Bloated stomach
- Change in the levels of certain chemicals in the blood
- Certain medicines, such as steroids, painkillers and some chemotherapy drugs
- Irritation to the diaphragm, caused by conditions such as an enlarged liver
- Irritation to the brain although this is rare.
Treatment for hiccups
Some people find that home remedies can help them get rid of hiccups more quickly. These include:
- Sipping iced water or swallowing crushed ice
- Holding your breath
- Breathing into a paper bag
- Pulling your knees up to your chest.
- Drinking from the wrong (opposite) side of a cup
- Swallowing dry bread
- Quickly swallowing two teaspoons of granulated sugar
- Biting on a lemon
If your hiccups don’t go away after a couple of days or if they keep coming back, you should tell your doctor. There are medicines they can prescribe that may help. The best treatment for hiccups depends on the cause. Treatments that may help if you have a bloated stomach include:
- Drinking peppermint water, which relaxes the stomach and gullet, helping to release trapped air through burping
- Anti-wind or antacid medicines (for example Asilone®)
- Some anti-sickness medicines, for example metoclopramide and domperidone.
You shouldn’t take peppermint water and metoclopramide at the same time, because they work against each other. Peppermint relaxes the stomach muscle, but metoclopramide stimulates it so that the stomach empties more quickly. If you’re started on a drug treatment for hiccups, your doctor will usually check with you about three days later to see how well it‘s working. If the hiccups haven’t gone away the dose may need to be increased, or you may need to try another drug.