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 is related with oral moisture condition and oral health. Wu et al reported that oral care intervention in patients with end stage of cancer reduced detection of Candida on the tongue, accompanied by a decrease in OHAT score [56], which was confirmed by the present results. OHAT criteria for assessments of lip, tongue, gum tissues, and saliva include dryness, with oral dryness one of the significant factors related to fungal colonization in the oral cavity [57,58].…”

Comparison of the Amount of Used and the Ease of Oral Care between Liquid and Gel-Type Oral Moisturizers Used with an Oral Care Simulators

“…A sponge brush, a toothbrush, an oral care gauze, an aspirator with a suction tube, and water or a gel-like oral moisturizer (hereinafter referred to as gel) were used. Oral care was performed in a series of steps, as follows [24]: (1) the oral cavity was moisturized with an oral moisturizer and sponge brush; (2) pseudo-plaque was removed with a toothbrush; (3) dry sputum was collected with a sponge brush. This procedure was repeated to remove the pseudo-plaque.…”

Oral conditions and other symptoms among older persons in long‐term care facilities during the end of life

“…Effective intervention to prevent and control oral problems is necessary for long-term care facilities. 56 Uncontrolled oral problems contribute to worsening quality of life (QOL), particularly among the most vulnerable population, which is close to the end of their life. According to the Fédération Dentaire Internationale (FDI) World Dental Federation, a new concept of oral health has been adopted as "multifaceted and includes the ability to speak, smile, smell, state, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort, and disease of the craniofacial complex.…”