Table 3.
Management of common oral problems in palliative patients
| Oral lesion/condition | Non-dentist palliative care physician | Dentist-role and expertise |
|---|---|---|
| Xerostomia | Review medication | Specialized oral hygiene to remove coating or plaque by |
| Oral care is encouraged | dental hygienist or dentist | |
| Maintain hydration by regular, cold unsweetened drinks | Salivary substitutes or oral balance gel | |
| Ice to suck or sugar free chewing gum | Chlorhexidine gluconate 0.2%, mouthwash used twice daily for 1 min. Dilute1:1 with water if too strong | |
| Use of atomized water spray | ||
| Oral candidiasis | Nystatin suspension 1 ml, as a mouthwash then swallowed, 4 times daily for 7-14 days | Chlorhexidine gluconate 0.2%, mouthwash 10 ml twice daily |
| Fluconazole 50-100mg daily for 7-10 days if topical antifungal are ineffective | Dentures to be examined and cleaned thoroughly | |
| If angular cheilitis present Nystatin cream or Miconazole Gel topically 4 times a day | Scaling and polishing of teeth | |
| For persistent infection further investigation will be required | ||
| Angular cheilitis | Antifungal agent or antibacterial agent | Clan and fit dentures and dental prosthesis |
| Nystatin suspension, or miconazole gel (topically 4 times daily) | ||
| Multivitamin supplementations | ||
| Denture stomatits | Eased by using an anti-fungal agent or antibacterial agent | Realignment of dentures and dry mouth product (Mucco, Biotene, KY gel) can be placed under dentures for comfort |
| Keep dentures clean by scrubbing and then soak dentures daily in solution of ½ water to ½ vinegar | Professionally cleaning and polishing of denture | |
| Mucositis | If painful mucositis, benzydamine hydrochloride 0.15% (Difflam) 15 ml 2-3 hourly for up to 7 days. Dilute 1:1 with water if stings. | Dental prosthesis to be removed and thoroughly cleaned and rectified of any technical error |
| For analgesia: soluble paracetamol gargle | Mouth washes to be administered as per need and clinical picture of the lesions | |
| Consideration of co-codamol or morphine – if more severe pain | ||
| Dysphagia | Head of the bed to be raised for ease of the patient | Specialized oral hygiene to remove coating or plaque by |
| Use of suction machine if available | dental hygienist or dentist | |
| Removable of debris by gauze | Oral physiotherapy | |
| Ulceration | Identify cause if possible | Correction of ill fitting dentures or dental caries if present |
| Chlorhexidine gluconate 0.2% mouthwash twice daily | ||
| If persistent ulcers, consider sending a swab for culture | ||
| Treat herpetic ulcers on lips with topical acyclovir; use oral acyclovir for herpes infection in the mouth | ||
| If ulceration is foul smelling, Metronidazole 400 mg 3 times a day orally | ||
| If ulcers painful, use benzydamine hydrochloride 0.15% oral rinse, then topical steroid (e.g. hydrocortisone lozenge, triamcinolone in orabase). | ||
| Taste disorders | Treatment follows as of xerostomia | Topical application of analgesia |
| Avoid stimulating factors | Scaling and polishing of teeth | |
| Sore/dry lips | Water based lip balms | Consultation from the dentist for diagnosis |
| Symptomatic treatment to be followed |