Common mouth problems in palliative care include:
Mouth care is a very important aspect of palliative care in all care settings. When they're not managed, mouth problems can affect:
Any mouth problems should be assessed and treated as soon as possible.
Factors which contribute to mouth problems include:
Every patient with a terminal illness should be assessed for mouth problems regularly. Ask patients frequently if they have any of the common mouth problems listed above.
Ask them whether it’s painful to speak or swallow. Assess whether the patient is able to manage their own mouth care or if they need any help.
Check what medicines the patient is taking as many cause mouth problems:
If it’s within your role, you should carry out an examination. Make sure the patient has privacy before you start. Explain to them what you're going to do. Remove any dentures and use a torch so you can thoroughly examine the mouth, including the lips, teeth and tongue. Look for signs of:
Mouth problems can usually be diagnosed on examination alone. Blood tests can help to assess bleeding, and you might need to take swabs if you suspect an infection.
All patients should have basic mouth care every day. Good mouth care in someone’s last days and hours can help to keep them comfortable. Encourage patients to do as much as they can by themselves. Carers and family members can also help.
There are things you can do for all patients:
For patients who have their own teeth:
For patients with dentures:
If you have any concerns about specific mouth problems, speak to the patient’s GP, district nurse or specialist nurse, and consider referring them to a dentist. Below are some ways you can help manage mouth problems.
Dry mouth (xerostomia) is the subjective feeling of a dry mouth. It’s often associated with difficulties with speech, chewing, or swallowing, the need to keep drinking and changes in taste. People with dry mouth can develop a thick coating over the tongue and lining of the mouth.
To help someone with a dry or coated mouth, you can:
Towards the end of life, people often become less interested in eating and drinking. If the patient’s mouth becomes dry, you can moisten it to keep them comfortable.
If the patient is conscious, moisten their mouth every 30 minutes with water from a spray or dropper, or by placing ice chips in their mouth. If the patient is unconscious, use a spray, dropper or ice chips every hour.
Read more about caring for someone at the end of life.
Get advice from the patient’s doctor or dentist if they're having radiotherapy or chemotherapy.
The following can help to soothe sore mouths:
Oral thrush (candidiasis) is a common fungal infection for people living with a terminal illness. It looks like thick white patches coating the tongue and mouth. It can also be present in the throat and oesophagus (gullet).
Thrush can cause pain, and difficulty with swallowing and chewing. Treat it with antifungal tablets, liquids or topical mouth sprays. Ask the patient’s GP, district nurse or specialist nurse to arrange treatment.
Cold sores (herpes simplex) are also common when someone's unwell. A patient can only get cold sores if they already have the herpes simplex virus. Cold sores can happen when a patient is feeling run-down or has another infection.
The patient’s GP, district nurse or specialist nurse can provide anti-viral treatment. You can also support the patient by encouraging good fluid intake, changing the toothbrush regularly , keeping the mouth moist and giving painkillers if appropriate.
Bad-smelling breath can feel embarassing, so approach the topic sensitively. It can be caused by infections including abscesses, local tumours and poor oral hygiene. Good mouth care should improve bad breath but antibiotics might be needed for local infections and abscesses.
Patients might experience changes in taste. They might not want to eat the food they usually enjoy. Make sure they still eat and drink enough. Encourage them to eat what they do enjoy and offer foods and drinks they find appealing.
Drooling (excess saliva) is usually caused by difficulty swallowing saliva. It's common in patients with neurodegenerative disorders such as motor neurone disease (MND), Parkinson’s disease and multiple sclerosis.
Ask the patient's GP, district nurse or specialist nurse about treatment. Physiotherapy can help with positioning and suctioning. Speech and language therapists can advise on safe swallowing techniques.
Mouth problems can cause physical complications and be distressing for the patient. Involve the following specialists if you’re worried:
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