Palliative Care and the Mouth; Oral Problems in Palliative Care

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Palliative Care and the Mouth Oral Problems in
Palliative Care

• Emma Riley
• Macmillan Oral Health Practitioner

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Palliative care

• the active holistic care of patients with
  advanced,
• progressive illness. Management of pain and other
• symptoms and provision of psychological, social
  and
• spiritual support is paramount. The goal of
  palliative care
• is achievement of the best quality of life for
  patients and
• their families. Many aspects of palliative care
  are also
• applicable earlier in the course of the illness
  in conjunction
• with other treatments

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Palliative Care does not mean end of life

• When a patient is end of life they can be placed
  on the LCP

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Mouth care maintains

• Self-esteem
• Comfort
• Persons ability to communicate
• Socialise
• Enjoy food and drinks

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ORAL HYGIENE CARE

• A clean and infection clear mouth is a BASIC
  NEED.
• Heals(1993)states that a patients oral status is
  a good indication of the care received

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Assessment

• Identify patients at risk of oral problems and
  plan mouthcare
• radiotherapy/chemotherapy, Enteral fed,
  dysphagia, immunocompromised, oxygen and
  terminally ill.
• Drug history
• Antichloinergics(e.g. hyoscine) increase
  dry mouth.
• Bisphosponates-risk of osteonecrosis of the
  jaw, especially if oral/dental health is poor.

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Assessment

• Examine thoroughly with a torch and a tongue
  depressor.
• Remove dentures, avoid painful lips by
  lubricating. Assess for dryness, coating,
  ulceration or tooth decay. Assess for pain.
• Document findings accurately and assess often

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Helping the symptoms

• Acknowledge that there is a problem, dont just
  see it as par for the course
• Maintain good oral hygiene.
• Try one of the various products available.
• Reassess to see if there has been any
  improvement.

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Toothbrushes
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Toothpastes
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Swabs
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EDENTULOUS PATIENTS

• GENTLY RETRACT CHEEKS AND WITH GENTLE STROKES
  BRUSH INSIDE SURFACES
• USING GAUZE HOLD THE TONGUE AND GENTLY BRUSH REAR
  TO FRONT
• GENTLY BRUSH PALATE
• ASPIRATE IF AIRWAY IS AT RISK

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DENTURES

• BRUSH WITH WATER
• PAYING ATTENTION TO THE CLASPS
• RINSE WELL
• SALIVA SUBSTITUTE MAY BE USED BEFORE REPLACING
  DENTURE IN THE MOUTH

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And finally

• Quality of Life

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