Mouth Care Flashcards
1
Q
Maintenance of oral hygiene: Basics
A
Toothpaste/toothbrush (brush BID)
- Extra soft nylon toothbrush (bristles softened further with hot water), rinse between use and replace q3 months (or sooner if oral infection occurs)
- Electric toothbrush qith rotation-oscillation action may be better at removing plaque
- Mild, fluoridated, low-abrasive toothpaste. Consider unflavoured (can irritate mucosa)
- Consider secretagogue toothpastes for xerostomia
- Consider non-foaming toothpaste for patients with dysphagia
- If toothpaste is too irritating, soak in a saline solution or use plain water and also rinse the mouth with plain water or saline
- Toothetts, foam swabs not as effective
- Glycerine and lemon swabs inadequate for cleaning the oral cavity and glycerine can increase oral drying
Floss
- Once daily, unless hemostasis is an issue
2
Q
Oral Hygiene: Mouth Rinses
A
- May be useful for patients with xerostomia, but avoid alcohol which is drying
- Alternative: Saline/baking soda solution
Chlorhexidine gluconate oral rinse 0.12% BID
- Anti-plaque agent with effective antimicrobial and slight antifungal activity
- Will not remove established plaque
- Oral applicator (4 x 4 gauze on a stick) can be soaked and used to remove dried mucous and oral debris
- Use between brushing (some toothpaste additives can neutralize it) and ensure patients don’t rinse immediately after
- Causes tooth staining (corrected by dental cleaning)
- Can cause alterations in taste with prolonged use
- Not shown to be beneficial as prophylaxis or treatment of mucositis in rads or chemo - may be irritating
Hydrogen Peroxide rinse 1.5%
- Used to loosen and remove hardened debris and clean a coated tongue
- Can be irritating and may destroy health granulation tissue
- May increase and prolong severity of mucositis
- Indications: Fusobacterium oral infection
3
Q
Mouth Rinse: Hydrogen Peroxide
A
Hydrogen Peroxide rinse 1.5%
- Used to loosen and remove hardened debris and clean a coated tongue
- Can be irritating and may destroy health granulation tissue
- May increase and prolong severity of mucositis
- Indications: Fusobacterium oral infection
4
Q
Rinse for Fusobacterium oral infection
A
Hydrogen Peroxide rinse 1.5%
- Used to loosen and remove hardened debris and clean a coated tongue
- Can be irritating and may destroy health granulation tissue
- May increase and prolong severity of mucositis
- Indications: Fusobacterium oral infection
5
Q
Mouth rinse: Chlorhexidine
A
Chlorhexidine gluconate oral rinse 0.12% BID
- Anti-plaque agent with effective antimicrobial and slight antifungal activity
- Will not remove established plaque
- Oral applicator (4 x 4 gauze on a stick) can be soaked and used to remove dried mucous and oral debris
- Use between brushing (some toothpaste additives can neutralize it) and ensure patients don’t rinse immediately after
- Causes tooth staining (corrected by dental cleaning)
- Can cause alterations in taste with prolonged use
- Not shown to be beneficial as prophylaxis or treatment of mucositis in rads or chemo - may be irritating
6
Q
Denture care
A
- Should never be worn 24 hrs a day
- Daily brushing and soaking to avoid colonization, especially with candida
Cleaning:
- Denture brush and toothpaste specially formulated for dentures (regular toothpaste can damage)
- Stored in a well-identified container with either a denture cleaning solution or warm water
- Rinse mouth and dentures with water before reinsertion
Fit
- With emaciation, patients may complain that dentures are loose due to loss of oral fat pads
- Xerostomia may impact loss of denture adhesion
- Solution: Permanent denture reline or a temporary procedure with a commercial available kit to tighten the denture for a short period of time (2-6 weeks)
- Watch for tartar formation on dentures, which may cause irritation - requires professional cleaning
7
Q
Management of dentures in case of a suspected fungal infection
A
- Disinfect overnight in a dilute bleach solution (1 part 1% bleach: 80 Parts water) unless there is a metal clasp (can damage the metal component)
- Note household bleach is too strong, get specialised denture bleach
- May also use a topical antifungal (e.g. nystatin) to apply to the inner surface of the denture or brush the inside of the appliance
8
Q
Most likely causes of xerostomia
A
- Head and neck rads
- Mouth breathing
- Dehydration
- O2 therapy
Meds:
- TCAs (note desimpramine is less anticholinergic than amitriptyline)
- Antipsychotics
- Antihistamines
- Anticholinergics
- Opioids
- Anticonvulsants
- BB
- Diuretics
9
Q
How to manage xerostomia
A
- Oral hygiene
- Maintain moisture
- Ice chips
- popsicles
- Sugar free frozen fruit juice
- Tonic water
- Small sips of fluids or a water spray, and keep at bedside
- Use a humidifier in a room, especially during sleep - Stimulate saliva production (generally preferred)
- Sugarless gum or sugar free candy
- Ascorbic acid (relatively ineffective) or malic acid (more effective), but may cause oral discomfort, especially with mucositis or stomatitis - Artificial saliva or salivary substitutes
- Moisturizing gels may be very useful, keep at bedside and use sparingly on lips, tongue, and palate (taste may be an issue) - Specially formulated toothpaste
- Water based products for lip production
- Olive oil or sesame oil applied sparingly to mucosa
- May combat dryness and facilitate denture adhesion and comfort - Dietary tips
- Soften food or use purees
- Avoid dry foods (biscuits, cereal)
- Avoid caffeine containing drinks or alcohol - Drugs for salivary stimulatio
- Pilocarpine (often used with Sjogren’s etc.) - parasympathomimetic, side effects include sweating, HA, urinary frequency, vasodilatation
10
Q
Stomatitis
A
- Mucosal irritation
Due to:
- Intraoral fungal or herpetic infection in immunosuppressed patients
- Necrotizing gingivitis (fusobacterial origin) in patients with extremely poor oral hygiene
- Erosive lichen planus
11
Q
Mucositis
A
- Mucosal irritation, but typically used in reference to erythematous and ulcerative lesions caused by cancer therapies (rads, chemo, SCT)
- Can involve oral mucosa and other areas of the GI tract
Consequences:
- Pain/distress
- Nutritional compromise
- Increased susceptibility to local/systemic infections
12
Q
Candidiasis
A
- Fungal infections common in medically complex patients
- C. Albicans (most common), but other Candida species or aspergillus may be found
Risk factors:
- Immunosuppression
- HIV/AIDs
- Cancer tx
- Xerostomia
- DM (uncontrolled)
- Poor oral hygiened
- Prolonged used of dental prothesis
- Poor nutritional status
- Iron deficiency
- Oral steroids or steroid inhalers
- Antibiotic use
13
Q
Presentation of candidiasis
A
- Presentation may be multiple forms simultaneously
- Initial presentation often angular cheilitis
- S. aureus may be a secondary contributing pathogen
- Pseudomembranous form (thrush)
- White, yellowish plaques that can be wiped off, with erythematous mucosa beneath
- Most commonly on palate, buccal mucosa, dorsal tongue - Acute erythematous form (acute atrophic candidiasis)
- Erythematous, painful, atrophic areas on the palate or dorsal surface of the tongue
- Burning sensation, bitter or metallic taste - Chronic erythematous form (chronic atrophic candidiasis)
- Chronic erythema, edema, and small erosions or plaques with with a velvet texture
- Often found on the hard palate where the upper denture fits - Chronic hyperplastic candidiasis
- Leukoplakia-esque, with white or discoloured plaques that cannot be wiped off
- Associated with a burning sensation
- Often on the buccal mucosa or laterodorsal tongue
14
Q
Candidiasis: Pseudomembranous form
A
Pseudomembranous form (thrush)
- White, yellowish plaques that can be wiped off, with erythematous mucosa beneath
- Most commonly on palate, buccal mucosa, dorsal tongue
- Most common form of candidiosis
15
Q
Candidiasis: Acute erythematous form
A
Acute erythematous form (acute atrophic candidiasis)
- Erythematous, painful, atrophic areas on the palate or dorsal surface of the tongue
- Burning sensation, bitter or metallic taste
