An overview of mouth care in geriatric patients – a palliative approach

Palliative care focusses on methods that prevent and relieve suffering and improve quality of life. It focus on every stages of disease and is not limited to the end of life care.

Geriatric patients are susceptible to oral infections like salivary gland dysfunction, oro-mucosal infections, dysphagia and pain. Swallowing disorders can possibly lead to aspiration pneumonia.

Why oral health?

Oral health is very much important to carry out the day to day functions like speaking, eating and swallowing. Oral complications thus decreases the quality of life. A healthy oral habit improves confidence and tooth loss has an impact in self – esteem.

Common oral dysfunctions

The common oral problems that are found during the end stage of life is described here:

  • Salivary gland dysfunction: is a change in the output of salivary. It can be qualitative / quantitative. The normal salivary flow rate is 0.3 to 0.4 mL/min. hyposalivation decreases flow rate by <0.1 mL/min. Hyposalivation can lead to oral candidiasis, tooth decay and over keratinization of tooth dorsum.

Excess drooling or sialorrhea may be caused by certain neuromuscular dysfunctions like stroke, Parkinson’s        disease, Alzheimer’s disease, myasthenia gravis, cerebral palsy and amyotrophic lateral sclerosis. Sialorrhea can lead to skin irritation, dehydration and it also increases the risk of aspiration pneumonia.

 

  • Orofacial pain: orofacial pain conditions like myofascial pain and neuropathic pain can be seen during the end of life. Parafunctional conditions like clenching can lead to myofascial pain. Trigeminal neuralgia can also be seen which involve an electric shock like pain in one division of trigeminal nerve. Stroke or multiple sclerosis can lead to central neuropathic facial pain. Oral dysesthesia occurs with an oral burning due to xerostomia, taste changes and tingling.

 

  • Swallowing disturbances: dysphagia is commonly associated with neurologic disorders, brain tumors and malignancy of aerodigestive tract. Dysphagia can lead to poor nutrition or dehydration. It can also lead to aspiration pneumonia.

 

  • Odontogenic infections: oral infections can occur secondary to dental caries. Large dental caries can further lead to pulpal necrosis and secondary infection.

 

  • Viral infections: Herpes Simplex Virus can lead to cold sores which is manifested as lesions of tongue, oral mucosa and tongue.

 

  • Fungal infection: oropharyngeal candidiasis is common in geriatric patients. It is caused mainly by candida albicans. It is usually presented as pseudomembranous form with a yellowish curd like papules in the oral mucosa, oropharynx, tongue or palate.

 

Oral care

A proper oral care can reduce the risk of dental / oral dysfunctions.

  • Oral hygiene should be performed twice a day
  • Use a soft bristled toothbrush to avoid injury while brushing
  • Use a fluoride containing toothpaste
  • Rinse thoroughly with an alcohol free mouthwash or fresh water to decrease bacterial load.
  • Apply lanolin to moisten lips if lips are dry.

Management of common conditions

  • Restoractive work: replace the broken, decayed or missed teeth
  • Dental caries: use topical fluoride preparations. Caries with pulpal involvement require extraction
  • Dry mouth; use sugar free candy, mucosal lubricants and improve hydration.
  • Sialorrhea: medication like glycopyrrolate can be helpful
  • Swallowing disturbances: maintain nutrition and perform oral exercises
  • Oral candidiasis: use topical or systemic antifungal medication

Jose J Kochuparambil

I love the quote -' be the change that you wanna see in others'

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