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

Abstract

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.

Associations of streptococci and fungi amounts in the oral cavity with nutritional and oral health status in institutionalized elders: a cross sectional study

“…On the other hand, fungal amount was related with oral moisture condition and OHAT. Wu et al reported that oral care intervention in patients at the end stage of cancer reduced detection of Candida on the tongue, accompanied by a decrease in OHAT score [52], which was con rmed by the present results. OHAT criteria includes dryness in assessments for lip, tongue, gums and tissues, and saliva.…”

Importância da assistência odontológica nos cuidados paliativos de pacientes oncológicos: uma revisão integrativa da literatura

“…Caso seja necessário, o dentista pode extrair dentes com mau prognóstico e restaurar aqueles com cárie, além de realizar raspagem e profilaxia para remover biofilme e cálculos, o que reduz o risco de infecções orais após a terapia (Mol, 2010). Segundo Wu et al (2020), a investigação e a intervenção do cirurgião-dentista em pacientes oncológicos em cuidados paliativos se faz essencial no controle e tratamento das condições relacionadas ao fluxo salivar. Da mesma forma, caso seja necessário, o profissional pode extrair os dentes com mau prognóstico e restaurar aqueles com cárie, além de realizar raspagem e profilaxia para remover biofilme e cálculos, o que reduz o risco de infecções orais após a terapia e melhora, por consequência, a saúde desse indivíduo (Mol, 2010).…”

“…Como exposto por Wu et al (2020), a carência de informações propagadas ao paciente ou aos cuidadores sobre a correta higiene oral durante o tratamento, dificulta o estabelecimento da saúde dos tecidos dentais e periodontais. Dessa forma, a periodontite e a gengivite também estiveram associadas ao câncer (Venkatasalu et al, 2020;Amodio et al, 2014).…”

“…O cuidado com a higiene oral desses pacientes é primordial uma vez que restabelece o processo de ingestão dos alimentos, além de atenuar as complicações orais decorrentes do tratamento como a mucosite, a xerostomia e a candidíase, diminuindo o desconforto, assim como melhorando a capacidade de comunicação desses indivíduos na fase pré-morte com os seus familiares (Wu et al, 2020). No estudo realizado por Nakajima (2017), foi constatado que, quanto pior a ingestão oral de alimentos, maiores são as chances de problemas orais, sendo necessárias intervenções regulares do dentista, preferencialmente desde o início do tratamento, com o propósito de prevenir o agravamento da situação oral desses pacientes.…”

“…& Bumb, 2014;Wu et al, 2020).Ohno et al (2015), em pesquisa realizada no Japão, verificaram que 93% das instituições…”