Palliative Care

Question 1

What is palliative care

Answer 1

Care for people living with a terminal illness where a cure is no longer possible
Focuses on person rather disease
Provides relief from pain and other symptoms

Question 2

Mouth care

Answer 2

Maintain facial appearance,
Eating, drinking, talking, quality.of.life, communication

Question 3

Oral problems in palliative care

Answer 3

Chemotherapy, radiotherapy z stomatitis, mucositis, poor nutrition, dehydration

All causing:
Nausea, depression, antidepressants that can cause xerostomia, candida, pain etc
Depression can lead to social isolation-poor OH- perio disease- halitosis…

Question 4

Common oral symptoms in palliative care

Answer 4

Dry mouth
Mouth discomfort
Taste alterations
Difficulty chewing, swallowing, speaking
Halitosis
Infections

Question 5

Painful mouths can be caused

Answer 5

Generalised pain- candidiasis, mucositis (inflammation of mucus membranes)
Localised- tumour, aphthous ulcers, herpes, dental causes such caries etc

Question 6

Common dental problems

Answer 6

Lost or broken denture
Lost crowns, bridges
Lost restorations
Sharp teeth/restorations
Fractured teeth
Oral ulceration

Question 7

Advices for all pts

Answer 7

Keep mouth and lips clean
Maintain fluid intake
Apply water based gel to dry lips
Reduce sugar intake

Question 8

Xerostomia , common causes

Answer 8

Rheumatoid arthritis
SLE
Sjogrens syndrome
HIV
Stroke
Ageing
Anxiety
Chemotherapy
Radiotherapy
Drugs (opioids, diuretics, oxygen, antiemetics, antidepressants…)
Alcohol
Cystic fibrosis

Question 9

Signs of xerostomia

Answer 9

Lobulated tongue, sticky mucosa
Dry cracky lips

Question 10

The Challacombe scale

Answer 10

An oral dryness score
From 1 to 10.
One least severe, 10 most severe
Any more than 3-hogh risk

Question 11

Effects of xerostomia

Answer 11

Dental caries
Gingivitis
Halitosis
Altered taste
Candidiasis
Mouth ulcers
Fissuring of the tongue
Chewing problems
Oral discomfort

Question 12

Saliva composition and functions

Answer 12

99% water, 1% (mucin, electrolytes, enzymes, proteins)
Functions: lubrication, cleansing, taste, speech, mucosal protection, digestion…

Question 13

Management of dry mouth

Answer 13

Treat underlying disease
Reinforce OH
Dietary advice
Regular dental checks
Lubrication of lips
Regular sips of water-symptomatic relief
Saliva substitutes
Saliva stimulants

Question 14

Contraindications for Glandosane

Answer 14

Not to be prescribed to dentate patients as has low pH that can damage tooth enamel

Question 15

Oral thrush

Answer 15

White spors/plaque
Can be symptomatic or not (pain, loss of taste…)
Can be erythematous candidosis
Angular cheilitis - angle of the lips, cracking, may bleed, be crusty

Commonly due to candida (Albicans, tropicalis, glabrata…)

Question 16

Risk factors for thrush

Answer 16

Host factors- immunocompression, antibiotics, steroids, female gender, smoking, hospitalisation, smoking, nutritional deficiency

Intra-orwl factors- poor OH, salivary dysfunction, oral mucosal damage, dental prosthesis, changes to commensal flora

Question 17

Treatment for candidosis

Answer 17

Topical:
- Nystatin- keeping in mouth as much as possible, low risk of interactions and little side effects
- miconazole-oral gel, holding in mouth after food. First line treatment for angular cheilitis. Drug interactions with stations, calcium channel blockers, carbamezapine, midazolam; warfarin, phenytoin. If liver function is impaired ( due to absorption)

Systemic:
- fluconazole- interactions with warfarin, amitriptyline, clopodogrel, benzodiazapines
- targeted therapy

Question 18

Drugs causing dry mouth

Answer 18

Opioids
Anticholinergics-
Antidepressants
Diuretics
Oxygen

Question 19

Management of dry mouth

Answer 19

Treat the underlying disease, review medication, good OH, dietary advice, regular dental checks, regular sips of water, lubricate dry lips, saliva substitutes/stimulants (chewing
Sugar free gums/sweets, frozen juice juices, organic acids …