Oral Care

• Oral problems may affect many palliative care patients, and can have a significant impact on their self-esteem, oral functions, and quality of life.
• The aim of good oral care is to prevent problems before they arise, and to control undesirable symptoms. Hence this should be part of the daily routine of nursing care.

Oral candidiasis

Possible causes:

• Poor oral hygiene
• Dry mouth
• Antibiotic use
• Use of corticosteroids
• Immunosuppression

Management:

• Regular oral care
• Anti-fungal treatment
  • Nystatin suspension:
    

    500,000 units q.d.s. for 7-14 days, swish & retain solution in mouth for as long as possible (several min) before swallowing, avoid consumption of food/drinks 20-30min after.

  • PO/IV Fluconazole:
    

    Loading dose 200mg on day 1, maintenance dose 100mg once daily for 7-14 days.

Xerostomia

Possible causes:

• Xerogenic drugs (e.g. opioids)
• Radiation therapy to head & neck
• Oxygen use
• Mouth-breathing

Management:

• Regular oral care
• Frequent small amount of water/ sugar-free drinks or suck ice chips
• Mucosal lubricants/saliva substitutes (e.g., Oral 7 mouthwash/gel/spray)

• Saliva stimulation
  • PO Pilocarpine 5mg t.d.s.
  • Sugar-free candy
• Humidifiers
• Review use of xerogenic drugs

Stomatitis

Possible causes:

• Chemotherapy
• Radiation therapy to head & neck
• Infection
• Dry mouth

Management:

• Treat infection
• Regular oral care
• Avoid foods that trigger pain (e.g. acidic foods)
• Analgesic mouthwash
  
  • Benzydamine hydrochloride (Difflam).
• Topical analgesia
  
  • Choline salicylate oral gel
  • Carmellose paste (Orabase)
  • Lidocaine gel or spray
• Systemic analgesia
  
  • NSAIDs or opioids

Halitosis

Possible causes:

• Poor oral hygiene
• Dry mouth
• Tongue coating
• Spectrum of bacteria in saliva

Management:

• Regular oral care
  
  • For coated tongue:
    Dissolve sodium bicarbonate powder ¼ teaspoon in 30mls of water to clean coated tongue.

Assessment, appropriate treatment and adequate reassessment to evaluate treatment response form the basis of successful management of oral problems.

• Assess daily for signs or symptoms of oral problems
• Examine all areas of the oral cavity, including lips, tongue, teeth, oral mucosa
• Assess patient’s ability to perform oral care
  
  • If able, encourage toothbrushing at least twice daily and rinse with water or prescribed mouthwash after each meal
  • If not able, assist with oral care after meals or 3-4 times daily
  • For patients in terminal phase:
    Frequency of oral care should be determined on an individual basis. As patient comfort is priority, any oral care intervention that causes distress should be discontinued.