Palliative Care. FACT SHEET Dental Services. Information for Health Professionals. Daily oral hygiene

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1 Palliative Care Information for Health Professionals is offered at the end of life. It is classified as: Soothing (soothing anxieties or other intense emotions), treating symptoms only (alleviating pain and symptoms without eliminating the cause), and prevention of suffering. Oral Health is one of the key ways in which we can deliver care to the person to keep them comfortable and lessen their suffering. Daily oral hygiene The daily oral hygiene routine may change and no longer be appropriate. The person may be: peg fed receiving oxygen therapy suffering from Dysphagia (difficulty in swallowing) have fluid restrictions be on oral pain relief have good days and bad days This can be exasperated by: the lack of chewing ability mouth breathing pooling of food debris in the mouth xerostomia (dry mouth) difficulty in maintaining oral health nausea/vomiting This can then lead to: Oral Mucositis (inflammation and ulceration) infection (viral, bacterial, fungal) function disabilities taste alterations Burning Mouth Syndrome bleeding Trismus

2 Oncology treatments, especially to head and neck have well-known oral side effects and patients should always be provided with pre-treatment information on how to minimise these effects. Medications, poor nutritional intake, changes in diet and previous oral health problems can also contribute to the oral condition. Other non-malignant disease (e.g. HIV/AIDS) can have specific associated oral conditions. Key objectives for oral care The key objectives for oral care are to alleviate pain/discomfort and decrease the risk of infections and improve general well-being by: removing food debris and plaque keeping the lips and soft tissues moist and intact freshening the mouth and preventing halitosis regular oral assessments and appropriate interventions The dental team should be involved in management of dental decay, denture problems, periodontal disease or other oral concerns. Suspected infections, widespread ulceration, oral pain, facial swelling and significant changes in the oral condition should be reported to appropriate medical/dental professionals. Some treatments can be carried out in the home/care facility if necessary for severely debilitated patients. Good oral hygiene routines It is essential to maintain good oral hygiene routines specific to patient needs. Regular tooth brushing twice daily with a fluoride toothpaste (1450ppm). A small headed soft brush can be used for patients with particularly sore mouths and further softened with warm water. If toothpaste isn t tolerable then a nonflavoured/foaming alternative (OraNurse) could be used. The tongue can also be cleaned with a soft brush. Sponge /foam sticks are not recommended for use in the mouth due to their roughness and possible choking risk. Chlorhexidine (0.2%) mouthwash can be used daily. Effective denture care. Dentures should be cleaned outside the mouth, ideally brushed with soap and water and a 10 minute soak in an appropriate solution. Sodium hypochlorite solutions disinfect and are appropriate for acrylic dentures. They should be left stored in water overnight. Always rinse thoroughly before replacing in the mouth.

3 Dry Mouth (Xerostomia) can result from radiotherapy, disease, depression and medication. It increases the risks of oral infections, dental decay, gum disease and can result in discomfort, altered taste and difficulties with eating and speaking. Treatment includes: treat underlying cause if possible keep lips soft with aqueous cream/lip salve Vaseline is not recommended keep rehydrated with frequent sips/sprays of water stimulate saliva flow with sugar free gum/sweets if appropriate water based lubricants, KY jelly or Oral Balance Gel saliva substitutes avoid alcohol (including mouth rinses), spicy foods, dry or hard foods Glycerine/lemon products are not recommended as they can dry the mouth. Oral candidosis needs to be reported to medical/dental professionals to access treatment such as topical and/or systemic anti-fungal and appropriate preventive changes in oral care to include: good oral hygiene routines denture sterilisation with sodium hypochlorite or chlorhexidine. removal of dentures from the mouth for a period of time daily Please contact the domiciliary dentist for any concerns you may have regarding a palliative care patient. Dental Advice Line Tel:

4 Daily Oral Hygiene Chart Please comment and tick in each box 2 times daily when oral hygiene is under taken. Name: Date commencing: Daily comments Oral Health Activity undertaken: Date commencing: Daily comments Oral Health Activity undertaken: Monday AM Monday AM Tuesday AM Tuesday AM Wednesday AM Wednesday AM Thursday AM Thursday AM Friday AM Friday AM Saturday AM Saturday AM Sunday AM Sunday AM Comments (please use image to the right to identify)

5 Suggested Oral Health Personal Palliative Care Kit Moutheze Each MoutEze stick features a cone shaped head with smooth rounded filaments, which gently sooth the soft tissues when cleaning the oral mucosa. By applying a rotating action, MouthEze can collect debris as it cleans. MouthEze is for those people who are dependent or require assistance for mouth care and for people where conventional methods i.e. toothbrushes and sponge swabs are not suitable. Finger brush Tepe Special care toothbrush:super soft For use and for anyone with sore or very delicate oral issue. Toothbrush head is a round shape with a brush. It is made of a silica gel material which is very soft. Non-petroleum lip balm Non-foaming/Unflavoured toothpaste: OraNurse Without parabens, harsh preservatives or petrolatum. This toothpaste is specially formulated for people sensitive to strong flavours and does not contain sodium lauryl sulphate. Mouth wash. Alcohol free/for dry mouths Alcohol free mouth rinse does not contain alcohol, which is better for people with dry mouths. Oral Health Promotion Team, Somerset Primary Care Dental Services Tel: OHPOffice@sompar.nhs.uk Website: If you would like to contact our Patient Advice and Liaison Service (PALS) please telephone or pals@sompar.nhs.uk Headquarters: Somerset Partnership NHS Foundation Trust 2nd Floor, Mallard Court, Express Park, Bristol Road, Bridgwater TA6 4RN Tel: Fax: foundationtrust@sompar.nhs.uk Web: Date Issued: January 2017 Review Date: January 2019 Author: Somerset Primary Care Dental Service Version: 1