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AssessmentSpeech pathologists working in the area of palliative care report their main diagnostic tool for assessing oral health is observation*. Candida, herpes and debris in the mouth after swallowing are clearly visible and thus easily recognised by a speech pathologist and/or other members of the patient's health care team.In palliative care, Butticaz et al. (2003) stress the importance of preventive measures to ensure adequate oral health and tissue integrity and to maintain pleasure of the consumption of food and fluid. Speech pathologists working in the area of palliative care suggest that a good oral care regime will contribute to good oral health*. Regnard, Allport and Stephenson (1997) recommend good hydration, the twice daily brushing of teeth with a fluoride toothpaste and regular observation of the oral muscosa as a method of minimising problems in oral health. Should a patient develop an infection which requires intervention, there are many commercially as well as natural options available. CandidaCandida is the one of the most commonly observed oral health concerns noted in patients in palliative care (Auret, 2005; Hanson, 2004). In the treatment of candida, mouthwashes are generally used (Hanson, 2004; Butticazet al, 2003; Good & Stafford, 2001; Milligan, McGill, Sweeney & Malarkey, 2001). These mouthwashes are either rinsed around a patient's mouth or swabbed onto the affected area. Research by Good and Stafford (2001) suggests that Nystatin and Ketoconazole are two treatments which can be used on candida owing to supporting evidence from randomised controlled trials. They also discuss Amphotericin lozenges which they suggest are used without substantial evidence (Good & Stafford, 2001).Dry MouthA dry mouth is also a common problem affecting patients in the palliative care setting (Regnard, Allport & Stephenson, 1997; Hanson, 2004). Groher (1997) suggests that lemon-glycerine swabs are a good method to refresh the mouth. However, Milligan et al. (2001) warn that this can actually cause further dryness to the mouth in some patients. The use of such swabs and natural remedies such as dark grape juice, pineapple juice and paw paw tablets can also assist in the relief of symptoms of a dry mouth and combating thick tenacious saliva*. This is supported by the Motor Neurone Disease Associations of New Zealand (MNDANZ) (2001) and the United Kingdom (2001). The use of semi-frozen drinks and topical anaesthetics is advocated by Regnard, Allport and Stephenson (1997) as a treatment for a dry and painful mouth. Artificial saliva is also commercially available and can help to overcome the effects of an excessively dry mouth. Two companies which produce this product are Biotene and Orion. Information regarding their products can be found at:
HerpesHerpes, particularly the herpes simplex virus is also common in patients in palliative care (Auret, 2005; Hanson, 2004). Hanson (2004) reports the painful, yellow lesions are often seen on the oral muscosa and the lips and is best-treated using applications of Acyclovir, a view supported by Auret (2005).Excessive SalivaExcessive saliva is another oral condition that can be seen by a speech pathologist in the palliative care setting. The MND Association UK (2001) offers numerous suggestions for the treatment of this symptom including oral swabbing, sage capsules and pharmalogical interventions such as Atropine, Glycopyrrolate and Hyoscine.DebrisDebris in the mouth following the intake of food or fluid can result in not only poor oral hygiene and infection but also an increased risk of aspiration pneumonia. Checking the mouth is clear of any debris after eating/drinking as well as cleaning the patient's teeth and mouth can help minimise this risk (Hanson, 2004).ReferencesAuret. K. (2005). Sore mouth in hospice inpatients: incidence and results of microbiological assessments. Progress in Palliative Care, 13 3-6. Butticaz. G., Zulian. G., Preumont. M., & Budtz-Jorgensen. E. (2003). Evaluation of a Nystatin-containing mouth rinse for terminally ill patients in palliative care. Journal of Palliative Care, 19, 95-99. Groher, M. (1997). Dysphagia: Diagnosis and Management (3rd ed.). Boston: Butterworth-Heinemann. Good. P., & Stafford. B. (2001). Inpatient palliative medicine is evidence based. Palliative Medicine, 15, 493-498. Hanson. C. (2004). Mouth care - how important is it? Journal of Community Nursing, 18, 4-7. Mashford, M., Aranda, S., Ashby, M., Bowman, J., Brooksbank, M., Cairns, W., Currow, D., Hynson, J., Kissane, D., Maddocks, I., Mitchell, G., O'Connor, M., Poole, S., Ravenscroft, P., Robinson, J., & Smith, M. (2001). Therapeutic Guidelines: Palliative Care, Version 1. North Melbourne: Therapeutic Guidelines Limited. Milligan, S., McGill, M., Sweeney, M., & Malarkey, C. (2001). Oral care for people with advanced cancer: an evidence based protocol. International Journal of Palliative Nursing, 7, 418-426. Motor Neurone Disease Association of New Zealand (MNDANZ) (2001). A Problem Solving Approach for Health Professional. Retrieved July 6, 2005, from http://www.mndanz.org.nz/attachments/Motor_Neurone_PDF_File.pdf Motor Neurone Disease Association of The United Kingdom (MNDAUK) (2001). Saliva Control. Retrieved July 6, 2005, from http://mndallianceresources.org/documents/PDF/InfoP3Saliva.pdf Regnard. C., Allport. S., & Stephenson. L. (1997). ABC of palliative care: Mouth care, skin care and lymphoedema. British Medical Journal, 315, 1002-1005. Sykes. N. (2003). Gastrointestinal symptoms. In Morrison. R. & Meier. D. (Eds.), Geriatric Palliative Care (pp. 256-270). New York: Oxford University Press. | ||||||||||||||||||||||||||||||||||
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