Home Oral Care At The End Of Life

Introduction

At the end of life, nothing else is more essential other than maintaining comfort, alleviation of pain and prevention of infection. However, many people are unaware that in order to achieve these objectives, oral care plays an important role. This is definitely true especially when other diseases are more active, progressive and far more advanced which may influence the oral conditions. Among the risk factors which may contribute to this problems include receiving chemotherapy and radiotherapy, terminally ill, immunocompromised, elderly, difficulty in swallowing, stroke, fed with PEG or nasogastric tube and oro-pharyngeal problems. The aims of this article are to educate the public about the routine oral care which can be carried out for people at the end of life and also to familiarize carer about the common oral problems which may be experienced by the affected persons.

Regular Oral Hygiene Care at Home

Lips		Moisturize the lips with moist cloth or gauze and protect the lips with lubricant e.g oral balance gel
Teeth		Brush the teeth and the gums twice a day with fluoride toothpaste and use soft and small headed toothbrush Use dental floss to clean area in between of  the teeth
		Dental Floss
Tongue		Clean the tongue gently once daily using either  soft toothbrush or tongue scrapper		Tongue Scraper
Denture		Remove the dentures and clean the dentures in the morning and night with cloth and mild soap and water. Rinse the dentures with water after each meal. Place the dentures in clean water at night.

Common oral problems and how to care for it:

		Periodontal Disease
Gingivitis
Prevention Tips: Brush the teeth twice daily morning and night with fluoride toothpaste
Dental Caries		Prevention Tips : Routine tooth brushing and flossing Minimise sugary diet, if  on  sweetened medicine: rinse mouth after each intake, use of fluoride toothpaste and fluoride mouthwash
Dry Mouth		Coated Tongue		Tip-Tip Pencegahan : Frequent sips of water, keep hydrated, remove coating with moistened soft toothbrush, use of saliva substitute, rinse with alcohol free chlorhexidine 0.2% mouthwash twice daily

		Denture Stomatitis
Oral Thrush
Source : Mackie S, Munroe M, Caring for Smiles, NHS Healthy Scotland
Tip-Tip Pencegahan : Rinse with alcohol free chlorhexidine 0.2% mouthwash twice daily, use antifungal mouthwash (prescribed by dentist),avoid wearing the dentures temporarily; leave the denture out and clean it thoroughly

Conclusion

Maintaining good oral hygiene is the key factor for keeping a healthy mouth especially at the end of life stage. Carer has to asses and quickly detects any abnormality or pain in the mouth from time to time as this may prevent the disease progression and discomfort. The most important thing is to consult dentist immediately if any unfamiliar or abnormality noted

References

1. Chalmers J., et.al., In Info-Connect Oral Hygienecare for Palliative Care Residents in Nursing Homes, Iowa Geriatric Education Centre, University of Iowa, 2004
2. Rooney A., et.al., In Home Care of the Hospice Patient, Stamford: Purdue Pharma L.P, 2013: 14
3. Wiseman M., The treatment of Oral Problems in the Palliative Patient, Journal of Canadian Dental Association 2006, 72(5): 453-457