description: mouth care this module is going to review some key things care partners need to know...

Description: Mouth Care

This module is going to review some key things Care Partners need to know about mouth care.

Estimated time to complete: 30 Minutes

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Mouth Care Care Partner Health Education & The Nebraska Medical Center

Introduction:

People who receive high doses of cancer therapy may develop changes in their mouths. One of the changes is mucositis or redness and sores in the mucous membranes of the mouth.

One of the most important things the patient can do to minimize the effects of mouth sores and help prevent infections is frequent mouth care.

This module is going to review some key things Care Partners need to know about mouth care.

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Mouth Care Care Partner Health Education & The Nebraska Medical CenterFor the following questions, please click on your response.

How often should the patient complete mouth care?

A) 4 times daily to decrease mouth problem.

B) As long as the patient's mouth is okay, don't worry about it.

C) Before breakfast and before going to bed in the evening.

D) Once or twice a day, but stop if there is pain or bleeding.


Correct - The patient should do oral care at least 4 times a day. If the patient’s mouth becomes tender or mouth sores develop, the patient should do mouth care even more often.

If the patient is using Mycelex, the anti-fungal drug to prevent “Thrush”, a yeast infection in the mouth, we recommend doing mouth care after breakfast, after lunch, after dinner, and before bed so that

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Incorrect - The patient needs to do mouth care at least 4 times a day. If the patient’s mouth becomes tender or mouth sores develop, the patient should do mouth care even more often.

If the patient is using Mycelex, the anti-fungal drug to prevent “Thrush”, a yeast infection in the mouth, we recommend doing mouth care after breakfast, after lunch, after dinner, and before bed so that the Mycelex is not washed away with food.

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Incorrect - The patient should do mouth care at least 4 times a day. If the patient’s mouth becomes tender or mouth sores develop. The patient should do mouth care even more often.

If the patient is having pain, be sure he/she takes pain medication regularly.

If the patient is having problems with bleeding, he/she should stop using the toothbrush and floss, but continue to do mouth care, brushing the teeth with a toothette.

If the patient is using Mycelex, the anti-fungal drug to prevent “Thrush”, a yeast infection in the mouth, we recommend doing mouth care after breakfast, after lunch, after dinner, and before bed the Mycelex is not washed away with food.

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Incorrect - The patient should do mouth care at least 4 times a day. If the patient’s mouth becomes tender or mouth sores develop. The patient should do mouth care even more often.

If the patient is having pain, be sure he/she takes pain medication regularly.

If the patient is having problems with bleeding, he/she should stop using the toothbrush and floss, but continue to do mouth care, brushing the teeth with a toothette.

If the patient is using Mycelex, the anti-fungal drug to prevent “Thrush”, a yeast infection in the mouth, we recommend doing mouth care after breakfast, after lunch, after dinner, and before bed so the Mycelex is not washed away with food.

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Let's see how you do with some True/False questions about mouth care.

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The tongue should be cleaned during mouth care.

TRUE FALSE


Correct, the tongue needs to be cleaned during mouth care.

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Actually, the tongue needs to be cleaned during mouth care.

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The teeth should be cleaned during mouth care.

TRUE FALSE


Correct, the teeth need to be cleaned during mouth care.

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Actually, the teeth needs to be cleaned during mouth care.

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The inside of the cheeks should be cleaned during mouth care.

TRUE FALSE


Correct, the inside of the cheeks

need to be cleaned during mouth care.

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Actually, the inside of the cheeks

need to be cleaned during mouth care.

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The roof of the mouth should be cleaned during mouth care.

TRUE FALSE


Correct, the roof of the mouth needs to be cleaned during mouth care.

All areas of the mouth including the tongue, teeth, inside of the cheek, and roof of the mouth need to be cleaned during mouth care.

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Actually, the roof of the mouth needs to be cleaned during mouth care.

All areas of the mouth including the tongue, teeth, inside of the cheek, and roof of the mouth need to be cleaned during mouth care.


Now let’s see if you can identify the correct products your family member may use for mouth care. We’ll list the product, you tell us if the patient may use it for mouth care.

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Can a soft toothbrush be used for mouth care?

YES NO


Correct, the patient is to use a new soft-bristled toothbrush unless bleeding becomes a problem.

If bleeding becomes a problem, the patient should switch to toothettes to brush his/her teeth until their platelets have recovered.

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Actually, the patient does need to use a new soft bristled toothbrush unless bleeding becomes a problem.

If bleeding becomes a problem, the patient should switch to toothettes to brush his/her teeth until their platelets have recovered

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Can toothpaste be used for mouth care?

YES NO


Correct, the patient can use any toothpaste he/she likes but they should try to avoid toothpaste with too many extra chemicals such as “Extra Whiteners.”

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No, the patient will want to use toothpaste. The patient can use any toothpaste he/she likes but should try to avoid toothpaste with too many extra chemicals such as “Extra Whiteners.”


Can dental floss or dental tape used for mouth care?

YES NO


Yes, the patient can use dental floss or tape. He/she should floss gently but if pain, tenderness, or bleeding occurs, the patient should stop using the dental floss or tape until the mouth recovers.

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Actually, the patient can use dental floss or dental tape. He/she should floss gently but if pain, tenderness, or bleeding occurs, the patient should stop using the dental floss or tape until the mouth recovers.


Can whitening strips be used for mouth care?

YES NO


No, the patient should avoid using products that can irritate the mouth or gums, such as whitening strips.

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Correct, the patient should avoid using products that can irritate the mouth or gums, such as whitening strips.


Can normal saline be used for mouth care?

YES NO


Correct, normal saline is our first choice for mouth care. If the patient is unable to tolerate the salty flavor of the normal saline, discuss this with your nurse. The nurse can switch the patient to plain water.

Doing mouth care consistently is most important. The patient should try to use the normal saline but there are other options.

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Actually, normal saline is our first choice for mouth care. If the patient is unable to tolerate the salty flavor of the normal saline, discuss this with your nurse. The nurse can switch the patient to plain water.

Doing mouth care consistently is most important. The patient should try to use the normal saline but there are other options.


Can Amerigold® mouthwash with normal saline be used for mouth care?

YES NO


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Correct, patients can flavor the normal saline mouthwash with and alcohol-free mouthwash such as Amerigold®.


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Actually, patients can flavor the normal saline mouthwash with and alcohol-free mouthwash such as Amerigold®.


YES NO

Can Listerine® antibacterial mouth wash with normal saline be used for mouth care?


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Sorry, patients should avoid using products with high alcohol content such as Listerine® and many other commercial mouthwashes. The alcohol can burn and dry the mouth.

If the patient wants a different product to flavor the normal saline mouthwash, there are many alcohol-free mouthwashes .


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Correct, patients should avoid using products with high alcohol content such as Listerine® and many other commercial mouthwashes. The alcohol can burn and dry the mouth.

If the patient wants a different product to flavor the normal saline mouthwash, there are many alcohol-free mouthwashes available at area stores .


Can toothettes be used for mouth care?

YES NO


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Correct, toothettes are used to swab the inside of the mouth. They can be used to brush the teeth if the gums become too tender for a toothbrush.


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Toothettes are part of the routine mouth care supplies. They are used to swab the inside of the mouth. They can be used to brush the teeth if the gums become too tender for a toothbrush.


Can lemon-glycerin swabs be used for mouth care?

YES NO


Sorry, lemon-glycerin swabs may make the mouth and lips look moist and smell fresh, but the glycerin will dry and irritate the mouth and should NOT be used.

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Correct, lemon-glycerin swabs may make the mouth and lips look moist and smell fresh, but the glycerin will dry and irritate the mouth and should not be used.


We are now going to show you a short video clip and ask you a couple of questions.

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PROPERTIESAllow user to leave interaction: AnytimeShow ‘Next Slide’ Button: Show upon completionCompletion Button Label: Click here when you are finished watching the video...


For the following questions, please select the best answer.

Did the patient in the video do mouth care correctly?

A) Yes

B) No.

C) Not Certain.


Do you really think we would show you a video and have everything perfect? There was a mistake, look again.

Back


Correct! Do you really think we would show you a video and have everything perfect. Now let’s see if you were just guessing, go on to the next question

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Do you really think we would show you a video and have everything perfect? There was a mistake, look again.

Back

THIS IS A DUPLICATE SLIDE OF 52?


For the following questions, please select the best answer.

What did the patient in the video do incorrectly?

A) “Re-dipped” the same toothette in the mouthwash.

B) Should have used a soft tootbrush to clean the inside of the mouth.

C) Should have gargled with mouthwash first.

D) Should have used toothpaste on the toothette.


Correct, patients should never re-dip used toothettes into the mouthwash. The patient should use as many of the disposable toothettes as needed to do mouth care.

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No, the mistake was dipping the toothette into the mouthwash twice. Patients should never dip a used toothette back into the mouthwash. Toothettes are disposable and should be tossed after removing them from the mouth the first time.

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We are now going to have you look at some pictures of mouths and then ask a question or two about each picture.

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If the patient's mouth looked like this, would you report it?

YES NO


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Correct, the nurse should be informed of changes in the patient’s condition including the condition of the mouth.


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Actually, there are changes that need to reported. Have another look before going on to the next question.


Why would you report this patient’s mouth to the nurse?

A) Sores on the inside of the lower lip.

B) Mouth is very dry.

C) Tartar on the lower teeth.

D) I wouldn't report it.


Correct, sores on the lips and in the mouth are a common problem after high-dose cancer treatment. These sores are a potential source of pain and infection and your nurse needs to be made aware of the problem.

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Actually, this patient’s mouth is quite moist. The patient has sores on the inside of his lower lip.

Sores on the lips and inside the mouth are a common problem after high-dose cancer treatment and are a potential source of pain and infection. Your nurse needs to be made aware of the problem.

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No, this patient has sores on the inside of his lower lip. His teeth are in fairly good condition.

Sores on the lips and inside the mouth are a common problem after high-dose cancer treatment and are a potential source of pain and infection and your nurse needs to be made aware of the problem.

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No, this patient has sores on the inside of his lip.

Sores on the lips and inside the mouth are a common problem after high-dose cancer treatment and are a potential source of pain and infection and your nurse needs to be made aware of the problem.

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YES NO

Let’s take a look at this next picture. Are there problems with this patient’s mouth that should be reported to the nurse?


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Actually, this patient’s mouth is in pretty good shape and there are no obvious changes to report at this time. If the patient had specific complaints of pain or burning, you would need to report these symptoms to the nurse.


Correct, this patient’s mouth is actually in pretty good shape and there are no obvious changes to report at this time.

If the patient had specific complaints of pain or burning, you would need to report these symptoms to the nurse.

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YES NO

We have a couple more. Look at this third picture. Are there problems with this patient’s mouth that you would report to the nurse?


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Correct, the nurse should be informed of changes in the patient’s condition including the condition of the mouth.


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Actually, there are are changes that need to be reported. Look again and go on to the next question.


Why would you report this patient’s mouth to the nurse?

A) Sores on the lower lip.

B) Sores on the side of the tongue.

C) Dry Tongue.



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Actually, the patient in this picture has sores on the side of his tongue that need to be reported. His lips may look a little dry, but there are no obvious sores on the lips. If the patient does develop sore on the lips, the nurse should be informed of this change in his mouth.


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Correct, this patient has sores on the side of his tongue. Sores on the lips and inside the mouth are a common problem after high-dose cancer treatment and are a potential source of pain and infection and your nurse needs to be made aware of the problem.


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Actually, this patient’s tongue does not look dry. This patient has sores on the side of his tongue that need to be reported.

Moisture changes are not uncommon after chemotherapy, but the critical finding here is the sore on the patient’s tongue.

Sores inside the mouth and on the lips are a common problem after high-dose cancer treatment and are a potential source of pain and infection and your nurse needs to be made aware of the problem.


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Actually, this patient has sores on the side of his tongue that should be reported to the nurse. Sores inside the mouth and on the lips are a common problem after high-dose cancer treatment and are a potential source of pain and infection and your nurse needs to be made aware of the problem.


YES NO

Now let’s look at one last picture. Are there problems with this patient’s mouth that should be reported to the nurse?


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Correct, the nurse should be informed of changes in the patient’s condition including the condition of the patient’s mouth.


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No, the nurse should be informed of changes in the patient’s condition including the condition of the patient’s mouth.

Have another look before going on to the next question.


Why would you report this mouth to the nurse?

A) Sores on the inside of the lower lip.

B) Sores on the side of the tongue.

C) White patches on the top of the tongue.



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Actually, this patient has white patches on the tongue These white patches can indicate a possible infection. The nurse needs to be made aware of the problem.


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Correct, white patches on the tongue can indicate a possible infection. The nurse needs to be made aware of the problem


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Actually, this patient has white patches on the tongue These white patches can indicate a possible infection. The nurse needs to be made aware of the problem.


Regular mouth care is very important during treatment and recovery. If the patient wanted to make a change in his/her mouth care which could he/she do without talking to the nurse?

A) Skipping the anti-fungal medication because it tastes bad

B) Using an over-the-counter herbal mouth rinse to freshen the breath and take the medicine flavor away

C) Changing to another alcohol-free mouthwash to flavor the normal saline mouthwash.


NO! The patient should never stop taking his/her anti-fungal medication without letting the nurse or doctor know. Stopping this medication may put the patient at risk for a fungal infection in the mouth. If the patient is unable to tolerate the anti-fungal medication it can be changed.

But DO NOT STOP IT WITHOUT TALKING WITH THE NURSE FIRST!!

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Correct, If the patient would like a different flavor or color, he/she can change to different mouthwash to flavor the normal saline mouthwash. But watch the alcohol content! The patient should select a low or alcohol-free mouthwash. Alcohol can burn or dry the patient’s mouth.

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During treatment and recovery the simplest of products can cause dangerous complications including over-the-counter medications and herbal products. The patient should never take a medication or use any product without first talking to the doctor and/or nurse.

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Suppose your family member develops mouth pain. Let’s review some decisions and possible changes you and the patient may have to make. Let’s start with food selections.

What food product should the patient AVOID when he/she has mouth pain?

Oatmeal?Popcorn?Pudding?


Actually, when the mouth is sore or tender, soft foods such as pudding may be better tolerated.

TRY AGAIN?


Correct, the patient may not be able to tolerate the rough texture of popcorn. Try soft foods when the mouth is sore or tender.

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Actually, when the mouth is sore or tender, soft foods such as oatmeal may be better tolerated.

TRY AGAIN?


What medications or products could the patient use to treat mouth pain?

A) Ativan (lorazepam)

B) Darvon-N (propoxyphene)

C) Vicks Chloraseptic Sore Throat Spray

Use the "Medication Administration Guide" handout to answer the question below. The guide is available via a printout or it can be accessed online by clicking here.


No, Ativan (lorazepam) is a prescription drug that may help the patient’s nausea or anxiety. It will not help the patient’s mouth pain, but it would not harm his/her mouth either and if ordered by the physician, it can be taken - just don’t use it to treat mouth pain.

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Yes, Darvon-N (propoxyphene) is a drug given for pain and it may be ordered to help treat the patient’s mouth pain.

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No, even though the Vick’s Chloraseptic Throat Spray® is an over-the-counter product, the patient should never use anything that the doctor or nurse is not aware of.

If the patient found Chloraseptic spray to be effective in the past, you can discuss it with the patient’s doctor and the doctor may order it, but DO NOT use it without consulting the doctor first!

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So, you’ve made some decisions about food and medications if the patient develops mouth pain. Let’s consider the patient’s mouth care routine.

If the patient develops mouth pain, what is an appropriate decision concerning mouth care routines?

A) Rinse his/her mouth with numbing “Magic Mouthwash” or “1-2-3 Mouthwash” instead of saline mouthwash.

B) Continue to use the saline mouthwash solution for oral care.

C) Add a water-pick to the mouth care routine to improve cleaning without rubbing.


Actually, the doctor may order a numbing mouth rinse such as “Magic Mouthwash” or “1-2-3 Mouthwash” but products like these should be used AFTER regular mouth care is done using the saline mouthwash solution.

If the patient does develop a sore mouth, he/she may wish to stop using the toothbrush and brush the teeth with a toothette instead. When the mouth becomes sore, mouth care should be done more that just 4 times a day.

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Correct, the patient should continue to use the saline mouthwash solution for oral care. If the mouth becomes sore the patient should do mouth care more often than 4 times a day but may wish to stop using the toothbrush and brush the teeth with a toothette instead.

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No, water picks may actually push bacteria into the tender tissues in the mouth. Water picks are not recommended.

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description: mouth care this module is going to review some key things care partners need to know...

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