Increased Cooperation with Dentistry by the Palliative Care Team

et al. 2019

Preprint

Background: In end-of-life patients with advanced cancers, oral examination, oral care, and oral re-examination are crucial. Although oral symptoms are among the major complaints of end-of-life patients, few studies have focused on oral care in these patients. In this study, the association between oral symptoms and oral dryness among end-of-life patients was examined, and improvement of oral conditions after oral care interventions by a professional dentist was quantified. Methods: This prospective intervention study included 27 terminally ill patients with advanced cancers in a hospice ward. Professional oral care was administered every morning, and the improvement of oral conditions was assessed by comparing oral conditions before and after the intervention. Oral assessment was performed using the Oral Health Assessment Tool (OHAT) and Oral Assessment Guide. Oral dryness was evaluated through Clinical Diagnosis Classification of oral dryness and an oral moisture device. Oral cleanliness was evaluated using a bacterial counter, and tongue smears were collected for Candida examination; furthermore, oral function was recorded. Results: The presence of oral mucositis was closely associated with severe oral dryness (odds ratio [OR] = 14.93; 95% confidence interval [CI]: 1.95–114.38). The level of oral debris retention was significantly related to the degree of oral dryness (OR = 15.97; 95% CI: 2.06–123.72). The group with higher scores (OHAT > 8), which represent poor oral conditions, showed severe oral dryness (OR = 17.97; 95% CI: 1.45–223.46). Total OHAT scores (median: 7 vs 2) and those of other subgroups (lip, tongue, gums and tissues, saliva, and oral cleanliness showed a significant decrease after the intervention. Furthermore, the occurrence of mucositis (47.1% vs 0%), candidiasis rate (68.8% vs 43.8%), oral dryness self-sensation (63.6% vs 9.1%), and severe oral debris (52.9% vs 11.8%) decreased significantly. Conclusions: Proper oral care can improve oral health and hygiene, reduce the rate of mucositis, reduce the sensation of oral dryness, increase oral moisture, and reduce the chances of oral infections among end-of-life patients. Daily oral care is necessary and can alleviate oral discomfort, increase food intake, and increase the chances of communication between end-of-life patients and their families.

Section: Discussionsupporting

confidence: 66%

“…In Taiwan, end-of-life oral care still receives less attention from physicians, nurses, caregivers, or patients themselves, similar to other countries [1][2][3][4]. In end-of-life patients, probably because of their weakness, oral symptoms are one of their major complaints of discomfort.…”

Section: Introductionmentioning

confidence: 99%

Professional oral care in end-of-life patients with advanced cancers in a hospice ward: Improvement of oral conditions

et al. 2019

Preprint

“…Despite the multitude of di culties, administering oral care to terminally ill patients is necessary. In a previous study, oral care was shown to increase oral moisture levels, provide relief from oral symptoms, provide a sensation of oral comfort, reduce the degree of dysgeusia, reduce the chances of odontogenic infections, increase the amount of food intake, and improve quality of life [4,5,8,[24][25][26]. Some conclusions were also provided by this present study.…”

Section: Discussionsupporting

confidence: 66%

Professional oral care in end-of-life patients with advanced cancers in a hospice ward: Improvement of oral conditions

et al. 2020

Preprint

Background: In end-of-life patients with advanced cancers, oral examination, oral care, and oral re-examination are crucial. Although oral symptoms are among the major complaints of end-of-life patients, few studies have focused on oral care in these patients. In this study, the association between oral symptoms and oral dryness among end-of-life patients was examined, and improvement of oral conditions after oral care interventions by a professional dentist was quantified.Methods: This prospective intervention study included 27 terminally ill patients with advanced cancers in a hospice ward. Professional oral care was administered every morning, and the improvement of oral conditions was assessed by comparing oral conditions before and after the intervention. Oral assessment was performed using the Oral Health Assessment Tool (OHAT) and Oral Assessment Guide. Oral dryness was evaluated through Clinical Diagnosis Classification of oral dryness and an oral moisture device. Oral cleanliness was evaluated using a bacterial counter, and tongue smears were collected for Candida examination; furthermore, oral function was recorded.Results: The presence of oral mucositis was closely associated with severe oral dryness (odds ratio [OR] = 14.93; 95% confidence interval [CI]: 1.95–114.38). The level of oral debris retention was significantly related to the degree of oral dryness (OR = 15.97; 95% CI: 2.06–123.72). The group with higher scores (OHAT > 8), which represent poor oral conditions, showed severe oral dryness (OR = 17.97; 95% CI: 1.45–223.46). Total OHAT scores (median: 7 vs 2) and those of other subgroups (lip, tongue, gums and tissues, saliva, and oral cleanliness showed a significant decrease after the intervention. Furthermore, the occurrence of mucositis (47.1% vs 0%), candidiasis rate (68.8% vs 43.8%), oral dryness self-sensation (63.6% vs 9.1%), and severe oral debris (52.9% vs 11.8%) decreased significantly.Conclusions: Proper oral care can improve oral health and hygiene, reduce the rate of mucositis, reduce the sensation of oral dryness, increase oral moisture, and reduce the chances of oral infections among end-of-life patients. Daily oral care is necessary and can alleviate oral discomfort, increase food intake, and increase the chances of communication between end-of-life patients and their families.

“…Some conclusions were also provided by this present study. The median (IQR) of survival days of our patients was 9 days (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and the mean (SD) was 10.85 (7.44). The average survival times were shorter than those in other countries [5,10].…”

Section: Discussionmentioning

confidence: 88%

“…In Taiwan, end-of-life oral care still receives less attention from physicians, nurses, caregivers, or patients themselves, similar to other countries [1][2][3][4]. In endof-life patients, probably because of their weakness, oral symptoms are one of their major complaints of discomfort.…”

Section: Introductionmentioning

confidence: 99%

Professional oral care in end-of-life patients with advanced cancers in a hospice ward: improvement of oral conditions

et al. 2020

BMC Palliat Care

Background In end-of-life patients with advanced cancers, oral examination, oral care, and oral re-examination are crucial. Although oral symptoms are among the major complaints of end-of-life patients, few studies have focused on oral care in these patients. In this study, the association between oral symptoms and oral dryness among end-of-life patients was examined, and improvement of oral conditions after oral care interventions by a professional dentist was quantified. Methods This prospective intervention study included 27 terminally ill patients with advanced cancers in a hospice ward. Professional oral care was administered every morning, and the improvement of oral conditions was assessed by comparing oral conditions before and after the intervention. Oral assessment was performed using the Oral Health Assessment Tool (OHAT) and Oral Assessment Guide. Oral dryness was evaluated through Clinical Diagnosis Classification of oral dryness and an oral moisture device. Oral cleanliness was evaluated using a bacterial counter, and tongue smears were collected for Candida examination; furthermore, oral function was recorded. Results The presence of oral mucositis was closely associated with severe oral dryness (odds ratio [OR] = 14.93; 95% confidence interval [CI]: 1.95–114.38). The level of oral debris retention was significantly related to the degree of oral dryness (OR = 15.97; 95% CI: 2.06–123.72). The group with higher scores (OHAT > 8), which represent poor oral conditions, showed severe oral dryness (OR = 17.97; 95% CI: 1.45–223.46). Total OHAT scores (median: 7 vs 2) and those of other subgroups (lip, tongue, gums and tissues, saliva, and oral cleanliness showed a significant decrease after the intervention. Furthermore, the occurrence of mucositis (47.1% vs 0%), candidiasis rate (68.8% vs 43.8%), oral dryness self-sensation (63.6% vs 9.1%), and severe oral debris (52.9% vs 11.8%) decreased significantly. Conclusions Proper oral care can improve oral health and hygiene, reduce the rate of mucositis, reduce the sensation of oral dryness, increase oral moisture, and reduce the chances of oral infections among end-of-life patients. Daily oral care is necessary and can alleviate oral discomfort, increase food intake, and increase the chances of communication between end-of-life patients and their families.