Oral Problems

Conditions that can affect oral care inpalliative care residents include:

• Dry mouth as a side effect of medicalconditions and medications

• Difficulties with speech, eating, andswallowing

• Nutritional deficiencies

• Diminished taste

• Burning mouth

•  Tooth hypersensitivity

• Rampant tooth decay

• Gingivitis (inflammation and bleedingof the gums) and plaque accumulation

• Problems wearing dentures

• Localized and generalized mouth pain

•  J aw pain and difficulty opening themouth

• Osteoradionecrosis of the jaw: injury tothe jaw as a side effect of radiationtherapy, often causing pain andswelling

• Mucositis: thinning of the oral mucosa,the tissue lining the mouth

• Mucosal bleeding of gums, cheeks,and tongue as a side effect of chemotherapy

• Apthous ulcers (canker sores), ulcersfrom infection, and other painfululcerations

• Bacterial infections in gums, sinuses,salivary glands, tooth nerve (pulp)

• Viral infections: HSV1, CMV, VZV,EBV, respiratory

• Fungal infections, both localized andsystemic

Dry Mouth

Types:

• Xerostomia: subjective feeling of having a dry mouth

• Salivary gland hypofunction (SGH):reduction in the quality and quantityof saliva

Caused by:

• Radiation therapy and chemotherapy

• Side effects of antipsychotic,antidepressant, antiparkinsonian,and antihypertensive medications,among others

• Medical conditions such as Sjögren’ssyndrome and Alzheimer’s disease

•  Terminal decline

IOWA 

GERIATRIC 

EDUCATION 

CENTER 

INFO-CONNECT Oral Hygiene Care for Palliative Care

Residents in NursingHomes

Rampant tooth decay & dry mouth in a bed-boundresident in late-stage Alzheimer’s d isease after 

prolonged use of antipsychotic medications

The Facts . . .

•  Traditional oral hygiene care may notbe appropriate for residents who areacutely sick, unconscious,non-responsive, or terminally ill.

• Palliative oral care focuses onstrategies for maintaining residents’quality of life and mouth comfort.

• Positioning during palliative oral care isimportant, as residents who lie flat mostof the time are at higher risk for chokingor developing lung infections such asaspiration pneumonia. 

• In the final stages, palliative careresidents may need to rinse theirmouths with water several times anhour to keep their mouths moist andcomfortable. 

 

Treatment:

• Increase water intake if possible (usespray bottles, ice chips, or rinses).

• Stimulate salivary flow with sugar-freegum or candy.

• If possible, switch to a medication withfewer oral side effects.

• Use toothpastes without additives(such as sodium lauryl sulfate) thatburn the mouth or use BiotenePrevident gel.

• Saliva substitutes are the preferredtreatment.

• Saliva stimulants (e.g., pilocarpine)can have many side effects andrequire careful consideration beforebeing prescribed.

• For severe dry mouth, apply Biotene orMI Paste inside the mouth.

• Keep Lanolin on the lips continually.

Saliva Substitutes

• A dry mouth can be very painful, withhigh risk of developing bacterial andviral infections.

• Saliva substitutes can make aresident’s mouth more comfortable.

• Unlike stimulants, saliva substitutesreplace saliva rather than increase theamount of saliva that is produced.

• Saliva substitutes usually come in theform of a gel or spray and can be usedas often as needed.

• In the final stages of illness, gently rubsaliva substitute in the resident’smouth every few hours.

• Rub a small amount of Lanolin orsaliva substitute on the caregiver’sgloved fingertips when accessing aresident’s mouth.

Excessive Saliva

• Some residents with swallowingproblems may at the same time haveboth a dry mouth and drooling fromexcessive saliva.

• Excessive saliva is a result of themuscles of the mouth and tongue notworking properly, so that saliva poolsin the mouth and flows out rather thanbeing swallowed.

•  These residents also may havesalivary gland hypofunction (areduction in saliva) and therefore canhave rampant oral disease.

• Medications that reduce salivaproduction are available, but thesehave many side effects and requirecareful consideration before beingprescribed.

Mouthrinses

• Residents needing palliative oralhygiene care are unlikely to be able torinse and spit mouthrinse.

• Most palliative care residents haveswallowing problems, so that anymouthrinse will run down the throat,increasing the risk of choking.

• Many mouthrinses contain alcohol,which will burn the resident’s cheeks,tongue, and other soft tissues,especially if the mouth is dry.

• If necessary, mouthrinse can beapplied using a small spray bottle.

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