Assessment of Dry Mouth in a Palliative Population: A Comparison Between Patient-Reported Symptoms and Clinical Oral Dryness Scale Measurements.

Small purposive sample from one specialist palliative service, mostly inpatients, so results may not apply to other palliative settings or outpatients. Only patients well enough to consent and with AKPS above 30% were included, excluding drowsy, cognitively impaired, very distressed or end-of-life patients. Recruitment was disrupted by a cyberattack and pandemic restrictions, limiting sample size and outpatient participation. The study is cross-sectional and observational, so it shows associations, not that dry mouth caused symptoms or that medication caused dry mouth. Assessments were made once, and not all participants were seen at the same time of day, so circadian saliva changes and medication timing may affect scores. The objective oral exam can be confounded by candida or tongue coating, and candida was absent in 57.5%, highly likely in 22.5% and undetermined in 20%. iPad images were not dental imaging quality. The PCOC Symptom Assessment Scale is a single global symptom rating and does not capture frequency or persistence of dryness. The modified Xerostomia Bother Questionnaire was adapted for this study, so its measurement properties are not established in the paper. Medication levels were not significantly correlated with dryness, so medication count cannot be used as a proxy for dry mouth severity.

Funding: Kerry Hospice Foundation funded the first author's master's fees. The authors declared no potential conflicts of interest.

Do not assume a mild or moderate visual mouth exam means the patient has little dry mouth. In this study, objective oral dryness was severe in only 5%, while 30% of patients rated their dry mouth severe and 52.5% rated it moderate.