Palliative Care and Palliative Care and the Mouth; Oral the Mouth; Oral Problems in Palliative Problems in Palliative Care Care Emma Riley Emma Riley Macmillan Oral Health Macmillan Oral Health Practitioner Practitioner
Feb 23, 2016
Palliative Care and the Mouth; Palliative Care and the Mouth; Oral Problems in Palliative Oral Problems in Palliative
CareCare
Emma RileyEmma RileyMacmillan Oral Health PractitionerMacmillan Oral Health Practitioner
Palliative carePalliative care‘…‘…the active holistic care of patients with advanced,the active holistic care of patients with advanced,progressive illness. Management of pain and otherprogressive illness. Management of pain and other
symptoms and provision of psychological, social andsymptoms and provision of psychological, social andspiritual support is paramount. The goal of palliative carespiritual support is paramount. The goal of palliative careis achievement of the best quality of life for patients andis achievement of the best quality of life for patients andtheir families. Many aspects of palliative care are alsotheir families. Many aspects of palliative care are also
applicable earlier in the course of the illness in conjunctionapplicable earlier in the course of the illness in conjunctionwith other treatmentswith other treatments
Palliative Care does not Palliative Care does not mean end of lifemean end of life
When a patient is end of life they When a patient is end of life they can be placed on the LCPcan be placed on the LCP
Mouth care maintains:Mouth care maintains:
Self-esteemSelf-esteem ComfortComfort Person’s ability to communicatePerson’s ability to communicate SocialiseSocialise Enjoy food and drinksEnjoy food and drinks
ORAL HYGIENE CAREORAL HYGIENE CARE
A clean and infection clear mouth A clean and infection clear mouth is a is a BASIC NEEDBASIC NEED..
Heals(1993)states that a patients Heals(1993)states that a patients oral status is a good indication of oral status is a good indication of
the care receivedthe care received
AssessmentAssessment Identify patients at risk of oral problems and plan Identify patients at risk of oral problems and plan
mouthcare: mouthcare: radiotherapy/chemotherapy, Enteral fed, radiotherapy/chemotherapy, Enteral fed,
dysphagia, immunocompromised, oxygen and dysphagia, immunocompromised, oxygen and terminally ill.terminally ill.
Drug history:Drug history: Antichloinergics(e.g. hyoscine) – increase dry Antichloinergics(e.g. hyoscine) – increase dry
mouth.mouth. Bisphosponates-risk of osteonecrosis of the Bisphosponates-risk of osteonecrosis of the
jaw, especially if oral/dental health is poor.jaw, especially if oral/dental health is poor.
AssessmentAssessmentExamine thoroughly with a torch and a Examine thoroughly with a torch and a
tongue depressor.tongue depressor. Remove dentures, avoid painful lips by Remove dentures, avoid painful lips by lubricating. Assess for dryness, coating, lubricating. Assess for dryness, coating,
ulceration or tooth decay. Assess for pain.ulceration or tooth decay. Assess for pain.
Document findings accurately and assess Document findings accurately and assess oftenoften
Helping the symptomsHelping the symptoms
Acknowledge that there is Acknowledge that there is a problem, don’t just see a problem, don’t just see it as “par for the course”it as “par for the course”
Maintain good oral Maintain good oral hygiene.hygiene.
Try one of the various Try one of the various products available.products available.
Reassess to see if there Reassess to see if there has been any has been any improvement.improvement.
ToothbrushesToothbrushes
ToothpastesToothpastes
SwabsSwabs
EDENTULOUS PATIENTSEDENTULOUS PATIENTS
GENTLY RETRACT CHEEKS AND WITH GENTLE GENTLY RETRACT CHEEKS AND WITH GENTLE STROKES BRUSH INSIDE SURFACESSTROKES BRUSH INSIDE SURFACES
USING GAUZE HOLD THE TONGUE AND GENTLY USING GAUZE HOLD THE TONGUE AND GENTLY BRUSH REAR TO FRONTBRUSH REAR TO FRONT
GENTLY BRUSH PALATEGENTLY BRUSH PALATE ASPIRATE IF AIRWAY IS AT RISKASPIRATE IF AIRWAY IS AT RISK
DENTURESDENTURES
BRUSH WITH WATERBRUSH WITH WATER PAYING ATTENTION TO THE CLASPSPAYING ATTENTION TO THE CLASPS RINSE WELLRINSE WELL SALIVA SUBSTITUTE MAY BE USED BEFORE SALIVA SUBSTITUTE MAY BE USED BEFORE
REPLACING DENTURE IN THE MOUTHREPLACING DENTURE IN THE MOUTH
Quality of LifeQuality of Life
And finallyAnd finally