Transcript Palliative Care in the Acute Setting

Oral Care
Aims
By the end of the session the participant will:
 Be familiar with the structures within and
around the mouth
 Be aware of the negative impact on general
health which can occur due to poor oral
health
 Know the correct equipment to use when
carrying out oral care
Oral Care
 Poor oral hygiene is a common cause of
distress for patients and families
 Poor care may be due to lack of training,
knowledge, inconsistent care
 Not always a high priority
 Essential for patient comfort
Risk Factors for Oral
Complications
 Systemically ill, terminal illness, unconscious
patient, tracheostomy
 Oxygen therapy, mouth breathing, nil by mouth.
 Naso – gastric/peg feeding
 Chemotherapy/radiotherapy, drug therapy
 Ill fitting dentures
 Diabetes
 Dementia
Consequences of poor oral
care
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Pneumonia
Septicaemia
Endocarditis
Pain
Xerostomia (dry mouth)
Halitosis
Difficulty eating and drinking
Withdrawal
Low mood
Good Oral Care
 Frequent inspection important using a pen
torch, tongue depressor and gloved finger
 Have an understanding of the possible risk
factors
 Examine in and outside the mouth
 Early detection/reporting of problems
 Need instruction on specific requirements
for that patient
Dentate Patients (own teeth)
 Brush teeth at least twice per day with
toothbrush and fluoride toothpaste
 Moisturise lips if necessary with a water
based lubricating gel
 ONLY use foam swabs soaked in water
if using a toothbrush is too painful or
impossible,
Care of Dentures
 Remove and brush with a toothbrush and
water after every meal
 Rinse mouth with water to remove debris
 Moisturise lips if necessary with water based
lubricating gel
 Remove and soak overnight in water
 If oral infection is present, e.g. candida,
dentures should be soaked in 1% sodium
hypochlorite solution 2ml mixed with 160ml of
tap water. If they have metal parts – soak in
chlorhexidine 0.2%
Oral Problems
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Candida (thrush)
Bacterial infections
Xerostomia(dry mouth)
Mucositis
Cold sores
Ulcers
Angular cheilitis
Candida
Dry mouth
 What causes a dry mouth?
 What problems can a dry mouth cause?
Causes
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Drugs – lots of them
Radiotherapy
Oxygen
Mouth breathing
Complications of dry mouth
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Decay
Gum recession and loss of teeth
Difficulty eating
Difficulty speaking
Trauma of mucosa
Halitosis
Dry Mouth (Xerostomia)
 Continue brushing teeth twice per day with fluoride
toothpaste
 Sips of and rinsing with tap water
 Artificial saliva – Avoid glandosane in patients with
their own teeth
Saliva Orthana has a porcine extract so is not
suitable for some patients due to culture
 Oral balance gel
 Sugar free chewing gum
 Review of medication
Cold sore
Aphthous ulcer
Angular cheilitis
Treatment of Painful Mouths
 Some patients may need pain relief such as cocodamol or even morphine in severe cases
 Avoid strong, acidic mouthwashes e.g. brand
makes
 Benzydamine (Difflam) mouth wash has local
anaesthetic. It can be diluted 1:1 if stinging
 Topical steroid for ulcers such as hydrocortisone
pellets
Practical Session…