![]() ![]() Include mouth care in the patient’s care plan. ![]() Patients receiving head and neck radiotherapy should avoid oil-based products.Patients may be advised to avoid anti-pyretic analgesics (paracetamol, aspirin) if at risk of neutropenia as this can mask fever due to sepsis.Refer to local cancer centre/cancer network guidelines.Mouth care if receiving chemotherapy/ radiotherapy – key difference Check dentures for cracks, sharp edges and missing teeth daily.2% solution for dentures with metal parts. dilute sodium hypochlorite solution for plastic dentures.Remove dentures at night and soak in a suitable cleansing solution forĢ0 minutes, then overnight in plain water.Rinse dentures thoroughly after meals and before replacing in the mouth.Denture cream or unperfumed soap may be used but not regular toothpaste. Use of a personal toothbrush and running water are adequate for the physical cleaning of dentures.Brush dentures at least twice a day over a sink of water to guard against splashing and prevent them from breaking if they are dropped.A denture fixative may provide relief from extensive movement of dentures.Mark all dentures with the patient’s name.Very soft toothbrushes (for example silk toothbrush or baby toothbrush) can be used to perform oral daily care for patients with a painful mouth.A dental hygienist or dentist can provide professional advice on oral hygiene for those with complex dental needs.Remove partial dentures and clean separately.The mouth should not be rinsed with water after brushing.Encourage patients to spit out excess toothpaste after brushing.Mechanical brushing of teeth and gums to remove plaque and debris is as important as application of toothpaste or chlorhexidine digluconate 1%w/w dental gel.Clean natural teeth with fluoride toothpaste (1350 to 1500ppm fluoride) after every meal, but at least twice daily if tolerated.Encourage and support family members who wish to participate in carrying out mouth care.Where there is concern about oral intake and nutrition, consider referral to a dietitian with consent.There may be additional oral care requirements as frequency of intake increases. Where possible reduce intake of sugary foods and drinks between meals (refer to Anorexia/Cachexia guideline).Apply water-based gel to dry lips after oral care.Encourage fluid intake with frequent, small drinks.Gentle tongue brushing should also be encouraged to reduce halitosis and prevent tongue coating.Keep mouth and lips clean, moist and intact by removal of plaque and debris (refer to section on dry/coated mouth care).Looking after oral soft tissues is just as important as looking after the teeth.When positioning is not possible, care should be taken to avoid collection of fluids in the oral cavity or aspiration. Oral care is most effective when the patient can be in a semi-upright position to avoid choking or aspiration of bacteria or debris.Consider dental referral with the patient’s consent for persistent oral symptoms or if it has been more than one year since the patient has been examined by a dentist.Look for signs of dryness, coating, ulceration, infection or tooth decay.Check the lining of the mouth is clean.Remove dentures before examining the mouth or performing routine mouth care.Previous applications of water-based lubricants should be gently removed before replacing.Petroleum lip balms should be avoided due to flammability and aspiration risk.Ensure comfort and minimise pain when carrying out an assessment by lubricating cracked lips with a water-based product.For patients at the end of life, ensure that active routine assessment is carried out.Ill-fitting dentures and surgical intervention including tooth extraction increase this risk, highlighting the need for preventative oral hygiene therapy. bisphosphonates increase the risk of osteonecrosis of the jaw.steroids increase the risk of candidiasis.opioids, diuretics and anticholinergics increase dry mouth.Medication history is important as numerous medications can affect the oral environment:.Patients who are receiving or have recently received chemotherapy or radiotherapy need careful monitoring both pre- and post-treatment.Identify serious oral problems that require referral, for example to palliative care specialist or a dentist.Plan regular effective mouth care for all patients.Assessment and intervention should be instigated early to optimise patient comfort and prevent more serious problems and treatment complications. Mouth care is an essential aspect of palliative care in all settings and should be considered part of daily routine patient care. ![]()
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