Palliative Treatment for Frail and Older Adults (Article 4 of 4)

The goal of palliative treatment is to enhance the quality of life during a painful episode  or for someone with a terminal illness A dentist's role could greatly enhance patient comfort and quality of life as the mouth is often the first site on pain.

  The first step in  palliative oral care is establishing good communication with the patient. With a good understanding of the patient's health circumstance, conducting a thorough oral exam  and asking for symptoms, severity and frequency is very important to determine the most bothersome issue and dealing with it promptly.

The most common oral complaint is dry mouth  If possible increase water consumption or use ice chips if choking is not a concern.. Foam swabs are helpful with providing moisture although not effective for plaque removal.  The swabs can be soaked  in warm salt water or an alcoholfree mouth rinse prior to swabbing the inside of patient's mouth.
 Daily oral hygiene is essential with modifications as needed for the palliative patient. An ultra soft  small toothbrush head can be used to promote comfort.

Candidiasis or fungal infections are common in palliative patients.  Anti fungal gels can be applied if patient cannot rinse.  Dentures can be scrubbed with soap and water and antifungal gel applied on the under surface of denture.

Preserving dignity is important part of palliative care. Maintaining a satisfactory facial appearance may be important to some patients and dentures, if needed should be made.

This concludes the series on dental care for the older adults.  Call 909 627 6699  or visit www.mydentistchino.com for more information.

Dry Mouth

Dry mouth, also called xerostomia is the condition of not having enough saliva, or spit, to keep the mouth wet.  Dry mouth can happen to anyone occasionally—for example, when nervous or stressed.  However, when dry mouth persists, it can make chewing, eating, swallowing and even talking difficult.  Dry mouth also increases the risk for tooth decay because saliva helps keep harmful germs that cause cavities and other oral infections in check.

Causes

Dry mouth occurs when the salivary glands that make saliva don't work properly.  Many over-the-counter and prescription medicines, as well as diseases such as diabetes, Parkinson's disease and Sjogren's syndrome, can reduce saliva formation. .  Other causes of dry mouth include certain cancer treatments and damage to the glands' nerve system.  It's important to see your dentist or physician to find out why your mouth is dry.

Treatment

Depending on the cause of your dry mouth, your health care provider can recommend appropriate treatment. There are also self-care steps you can take to help ease dry mouth, such as drinking plenty of water, chewing sugarless gum, and avoiding tobacco and alcohol.  Good oral care at home and regular dental check-ups will help keep your mouth healthy.

“Frequent use of moistening rinses along with topical fluoride applications and increasing dental recare visits are preventative measures that greatly enhance oral health” says Dr. Cherukuri from her Chino, California  dentalpractice

Oncology Pocket Guide to Oral Health- Part 2

Chemotherapy

The oral complications of chemotherapy depend on the drugs selected, dosages, the degree of dental disease, and use of radiation. Chemoradiation therapy carries a significant risk for mucositis.
Before Chemotherapy

• Refer patients to a dentist for a pretreatment oral health examination, 1 month, if possible, before cancer treatment begins.
• Tell the dentist the treatment plan and timetable.
• Advise the dentist if radiation therapy is also planned.
  
• Allow at least 7 to 10 days of healing from oral surgical procedures before the patient begins myelosuppressive therapy.
  
• Check for immunosuppression or thrombocytopenia before any oral procedures in patients with hematologic cancers.

During Chemotherapy

• Consult with the oral health team to schedule dental treatment.
  
• Conduct blood work 24 hours before any dental procedure. Postpone if
  • platelet count is less than 75,000/mm³, or abnormal clotting factors are present.
  • neutrophil count is less than 1,000/mm³.
• Determine if there is a need for antibiotic prophylaxis before any dental procedures in patients with central venous catheters.
  
• Consult the dentist to explore a possible oral source of infection when fever is of unknown origin.
  
• Ask patients frequently about their oral health.

After Chemotherapy

• Resume a regular dental recall schedule when chemotherapy is completed and all side effects, including immunosuppression, have resolved. 

Visit www.chinosmiles.com for more information.