Oral Health Care - basic or essential? Candy Cooley Manager National Genetics Education and Development Centre, Birmingham, U.K.

Why Oral Health care? Patient comfort & well being Patient comfort & well being Maintenance of nutritional status Maintenance of nutritional status A judgement on nursing care? A judgement on nursing care? Tradition Vs Evidence based Tradition Vs Evidence based

The Purpose of Oral Health Care Maintain comfort Maintain comfort Maintain function Maintain function Maintain moisture Maintain moisture Maintain integrity Maintain integrity Maintain cleanliness and freshness Maintain cleanliness and freshness

Communicating Facial appearance Eating Drinking ORAL HEALTH Means: Being loving!

Aims of this session: Prevention Prevention Protection Protection Monitoring Monitoring Treatments Treatments

Multifactoral problems Regular dental care Regular dental care Dietary intake Dietary intake Oral damage Oral damage  Disease  Infections  Treatments

Regular Oral Assessment Normal physiology of the mouth Normal physiology of the mouth Good assessment of current oral status (Adams 1993) Good assessment of current oral status (Adams 1993)

Use of Assessment Tools Baseline assessment(Holmes 1993) Baseline assessment(Holmes 1993) What is regular? What is regular? Which tool to use (OAG1,2,3) Which tool to use (OAG1,2,3) Interpretation of results Interpretation of results Need to undertake a good ‘look’ Need to undertake a good ‘look’

Regular Oral Assessment Normal physiology of the mouth Good assessment of current oral status (Adams 1993) Identification of risk Identification of risk

Regular Oral Assessment Normal physiology of the mouth Good assessment of current oral status (Adams 1993) Prevention/early identification of infection Prevention/early identification of infection

MUCOSITIS

Presentation Inflammation of the mucous membranes of the GI tract ( plus all epithelial cells; eyes, nose, vagina, bladder) Inflammation of the mucous membranes of the GI tract ( plus all epithelial cells; eyes, nose, vagina, bladder) Oral presentation Oral presentation  dry mouth and lips  whitish patches

Mucositis common sites Soft palate Soft palate Right & left buccal mucosa Right & left buccal mucosa Tongue Tongue Floor of mouth Floor of mouth

Risk Factors Younger than 20 years Younger than 20 years Pre-existing periodontal disease Pre-existing periodontal disease Head and Neck malignancies Head and Neck malignancies Drug combinations- Cisplatin and 5FU Drug combinations- Cisplatin and 5FU AIDS AIDS Concomitant radiation Concomitant radiation Women Women White patients White patients

Xerostomia- dry mouth mls saliva a day mls saliva a day Subjective symptom Subjective symptom 90 % of advanced cancer patients 90 % of advanced cancer patients 77% hospice in patients 77% hospice in patients Maybe reduced volume or composition Maybe reduced volume or composition

Xerostomia- causes Radiotherapy Radiotherapy Oral/Pharyngeal cancers Oral/Pharyngeal cancers Drugs Drugs Sjogrens syndrome Sjogrens syndrome

Xerostomia - symptoms Mouth discomfort Mouth discomfort Taste, chew, swallowing is all problematic Taste, chew, swallowing is all problematic Impacts on speaking Impacts on speaking Increases psychosocial problems Increases psychosocial problems Can lead to aspiration pneumonia and septicaemia Can lead to aspiration pneumonia and septicaemia All opioids cause some level of impact All opioids cause some level of impact

Xerostomia - support Chewing gum Chewing gum Saliva substitutes Saliva substitutes Gravy & sauces Gravy & sauces Drink with food Drink with food KY gel or Oral Balance KY gel or Oral Balance Working with the patient to find out what works best for them Working with the patient to find out what works best for them

Non-adherent white plaques

TREATMENT OF FUNGAL INFECTIONS Topical Nystatin Miconazole Clotrimazole Compliance?

TREATMENT OF FUNGAL INFECTIONS Systemic Fluconazole Fluconazole Itraconazole - capsules Itraconazole - capsules - liquid - liquid

Other Considerations Haemorrhage Haemorrhage Herpes viruses Herpes viruses

Evidence Based Practice Assessment of problem Assessment of problem Treatment decisions Treatment decisions Multi-professional Care Multi-professional Care Education Education

Nursing Care Toothbrush Toothbrush Water Water Floss Floss ice, pineapple, saliva substitutes ice, pineapple, saliva substitutes Education Education

Procedure for removing denture

Procedure for replacing dentures

Prevention / management – other treatments in the cupboard! Chlorhexidine Chlorhexidine Antifungal/ Antibacterial/ Antiviral Antifungal/ Antibacterial/ Antiviral Topical anaesthetics – Difflam, Bonjela, Gelclair Topical anaesthetics – Difflam, Bonjela, Gelclair Effervescent vitamin E 1000mg Effervescent vitamin E 1000mg Growth factors Growth factors Tea tree oil Tea tree oil

Confident Well Planned Care Aims of today Confidence to change practice Confidence to challenge practice

References Adams R (1996) Qualified Nurses lack of knowledge related to oral health Journal of Advanced Bagg J, Jackson M, Sweeney P, Ramage, G, Davies A (2006) Susceptibility to Melaleuca alternifolia (tea tree) oil of yeasts isolated from the mouths of patients with advanced cancer Community Dent Oral Epidemiol Apr ;33 (2): Buglass E A (1995) Oral Hygiene, British Journal of Nursing, 4(9): Cooley C (2002) Oral health: basic or essential care? Cancer Nursing Practice 1, 3, 33 – 39 Davies A, Findlay I (2005) Oral Care in advanced disease. Oxford Uni. Press Dodd, M et al (1996) Randomised Clinical Trial of Chlorhexadine Versus Placebo for Prevention of Oral Mucositis in Patients Receiving Chemotherapy. Oncology Nursing Forum, 23(6): Eilers, J et al (1998) Development, Testing, and application of the Oral Assessment Guide. Oncology Nursing Forum, 15(3): Ellershaw J, Ward C (2003) Care of the dying patient: the last few hours or days of life. British Medical Journal, 326, Evans G (2001) A rationale for oral care Nursing Standard 15, 43, Holmes, S, Mountain E (1993) Assessment of oral status: evaluation of three oral assessment guides. Journal Clinical Nursing 2, Holmes, S. (1996) Nursing Management of oral care in older patients, Nursing Times 92(9): Kite, K & Pearson, L (1995) A rationale for mouth care: the integration of theory with practice. Intensive and Critical Care Nursing, 11: Pearson, L S (1996) A Comparison of the Ability of Foam Swabs and Toothbrushes to Remove Dental Plaque: Implications for Nursing Practice, Journal of Advance Nursing, 213: Regnard, C et al (1997) Mouth care, skin care, and lymphoedema. BMJ, 18 October, 315, Sweeney, P. (1998) Mouth care in nursing – Part 1. Common oral conditions. Journal of Nursing Care, spring, 4-7. White, R. (2000) Nurse assessment of oral health: a review of practice and education. British

Thank you and any questions? Thank you and any questions?