Early diagnosis and treatment of oral conditions among palliative patients could minimize their pain and suffering. Forty percent of palliative patients lose their ability to communicate their oral health needs or have discomfort and, consequently, they may suffer treatable oral conditions for a prolonged period of time.

The following list summarizes the evidence on oral conditions among palliative patients.

Common oral conditions, in decreasing order, the most frequent are: xerostomia or dryness of mouth, candidiasis or oral thrush, dysphagia or swallowing difficulties, mucositis, orofacial pain, taste changes and ulceration, coughing, and oral discomfort.
Other conditions are stomatitis salivary hypofunction, mucosal erythema, fungal infection, periodontitis cold sores, dental caries, gingival inflammation, tongue coating and inflammation, bleeding spots, plaque, food particles and fungus infection, sores and scabs, viscous ropy saliva and chapped lips, halitosis, problems using dentures, problems with oral secretions, dysarthria, oral yeast carriage, mucosal friction, and short periods of ulceration and infection.

Social impact includes feeling worried, bothered, a feeling of reduced life satisfaction, shame, anxiety, depression, increased feelings of being a patient rather than a person, and not wanting people to be around them, which affects social interactions and results in loneliness. Functional impact includes difficulties in swallowing, speaking, eating, food restriction, the sensation of oral dryness and pain, which results in lack of food enjoyment.

Management options
• Xerostomia: drug and medical treatments, lubricating lips and mucosa, acupuncture, and standard oral care.
• Candidiasis: a single-dose fluconazole via mouth.
• Pain: indomethacin oral spray relieves pain after 25 minutes.

Some of the challenges in treating oral conditions among palliative patients are underestimation of reported oral problems and the lack of knowledge/routine, patient cooperation, resources, and priority given to oral problems, as well as difficulty in accessing the mouth and retching.

See reference for more information.

Adapted from Medscape. Drugs & perspective. BMC oral health. Oral health issues among terminally ill patients. Internet. Available at https://www.medscape.com/viewarticle/927958 Accessed on March 25, 2020. To view the entire article and all other content on the Medscape, a one-time registration is required.