MOUTH CARE

Mouth care is important. Debilitated patients commonly develop a sore, dry mouth and 70% of patients with advanced cancer develop oral thrush.

Routine mouth care involves:

• Rinsing with diluted mild mouthwash (every 12 hours)

• Brushing of teeth (every 12 hours)

• Soaking of dentures overnight

• Cleaning with Toothette (every 2 to 4 hours)

• Applying Vaseline to dry lips

Cleaning with a foam-stick applicator (Toothette) dipped in water or sodium bicarbonate (or impregnated with lemon glycerin) needs to be done after every meal and more frequently in patients who are mouth- breathing (consider using a room humidifier).

Patients should be encouraged to do their own mouth care to maintain their independence. For weak patients the nurse or family carer can use a Toothette, or put on a disposable glove and wrap gauze around a finger. If there is difficulty opening the mouth (in oropharyngeal cancers) irrigate regularly with a gentle mouthwash using a syringe and very soft mouth brush.

Radiotherapy to the mouth can cause extreme dryness and soreness. A mucilage of lemon syrup, water and methylcellulose (1:1:2) with soluble aspirin dissolved in it is soothing. The mouth should be rinsed regularly with diluted Peridex mouthwash to prevent gingivitis.

I.  Dry mouth – At least 50% of patients suffer from dryness of the mouth due to thrush (candidiasis), dehydration, effects of anti-cholinergic drugs, diuretics, or morphine.

Management options:

• 2-hourly mouth care

• Stop unnecessary drugs

• Treat for thrush

• Artificial saliva

• Suck ice

Mouth care needs to be performed every 2 hours for a dry mouth.

Drugs can cause dryness of the mouth (especially tricyclics, phenothiazines, diuretics). Stop unnecessary drugs or use ones with the least anti-cholinergic side-effects.

Thrush often presents as dryness, before soreness and the typical signs develop. All patients with advanced illness complaining of a dry mouth should be treated for thrush. Angular stomatitis is usually due to thrush (very rarely is it due to vitamin deficiency). The patient’s mouth should be gently inspected daily with a padded spatula and flashlight. (see Candidiasis)

Artificial saliva can be helpful, especially for the very dry mouth following radiotherapy. Drinks that stimulate the flow of saliva (mild lemon juice, grapefruit juice, tonic water, club soda) can be encouraged.

Crushed ice on a teaspoon is all that many patients need, particularly in the terminal phase.

II.  Sore mouth may be due to:

• Thrush

• Loose dentures

• Gingivitis

• Mouth ulcers

Management options:

• Always treat for thrush. (see Candidiasis)

• Dentures become loose and rub (because of weight loss and loss of oral tissue). It is a simple matter to reline dentures, and a visit to the dentist for that purpose can actually produce a disproportionate boost to morale.

• Gingivitis usually causes halitosis as well as soreness and should be treated with metronidazole.

• Mouth ulcers can be helped by triamcinolone acetonide dental paste applied 2 or 3 times a day, and at bedtime.

• Soreness of the mouth and throat can be treated symptomatically with viscous lidocaine mouth rinse.

III.  Coated tongue is unpleasant, can cause halitosis, and predisposes to oral thrush.

Management options:

• Effervescent Vitamin C tablets (where available), placed on the tongue and dissolved, 4 times a day.

• Fresh pineapple (which contains proteolytic enzyme, ananase). It can cause stinging which is reduced by freezing the slices and dipping them in powdered sugar.

• Hydrogen peroxide mouthwash froths and removes surface debris (in a mix of 2% hydrogen peroxide with water). Some patients find it unpleasant to use.

• Clotrimazole lozenges dissolved slowly in the mouth, for resistant thrush.

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.