Transcript Mucositis
Oral Health Care - basic or essential?
Candy Cooley Manager National Genetics Education and Development Centre, Birmingham, U.K.
Why Oral Health care?
Patient comfort & well being Maintenance of nutritional status A judgement on nursing care?
Tradition Vs Evidence based
The Purpose of Oral Health Care
Maintain comfort Maintain function Maintain moisture Maintain integrity Maintain cleanliness and freshness
ORAL HEALTH Means: Communicating Facial appearance Being loving!
Drinking Eating
Aims of this session:
Prevention Protection Monitoring Treatments
Multifactoral problems
Regular dental care Dietary intake Oral damage Disease Infections Treatments
Regular Oral Assessment
Normal physiology of the mouth Good assessment of current oral status (Adams 1993)
Use of Assessment Tools
Baseline assessment(Holmes 1993) What is regular?
Which tool to use (OAG1,2,3) Interpretation of results Need to undertake a good ‘look’
Regular Oral Assessment
Normal physiology of the mouth Good assessment of current oral status (Adams 1993) Identification of risk
Regular Oral Assessment
Normal physiology of the mouth Good assessment of current oral status (Adams 1993) Prevention/early identification of infection
MUCOSITIS
Presentation
Inflammation of the mucous membranes of the GI tract ( plus all epithelial cells; eyes, nose, vagina, bladder) Oral presentation dry mouth and lips whitish patches
Mucositis common sites
Soft palate Right & left buccal mucosa Tongue Floor of mouth
Risk Factors
Younger than 20 years Pre-existing periodontal disease Head and Neck malignancies Drug combinations- Cisplatin and 5FU AIDS Concomitant radiation Women White patients
Xerostomia- dry mouth
500-600mls saliva a day Subjective symptom 90 % of advanced cancer patients 77% hospice in patients Maybe reduced volume or composition
Xerostomia- causes
Radiotherapy Oral/Pharyngeal cancers Drugs Sjogrens syndrome
Xerostomia - symptoms Mouth discomfort Taste, chew, swallowing is all problematic Impacts on speaking Increases psychosocial problems Can lead to aspiration pneumonia and septicaemia All opioids cause some level of impact
Xerostomia - support Chewing gum Saliva substitutes Gravy & sauces Drink with food KY gel or Oral Balance Working with the patient to find out what works best for them
Non-adherent white plaques
TREATMENT OF FUNGAL INFECTIONS
Topical • • • Nystatin Miconazole Clotrimazole Compliance?
TREATMENT OF FUNGAL INFECTIONS
Systemic Fluconazole Itraconazole - capsules - liquid
Other Considerations
Haemorrhage Herpes viruses
Evidence Based Practice
Assessment of problem Treatment decisions Multi-professional Care Education
Nursing Care
Toothbrush Water Floss ice, pineapple, saliva substitutes Education
Procedure for removing denture
Procedure for replacing dentures
Prevention / management – other treatments in the cupboard!
Chlorhexidine Antifungal/ Antibacterial/ Antiviral Topical anaesthetics – Difflam, Bonjela, Gelclair Effervescent vitamin E 1000mg Growth factors Tea tree oil
Confident Well Planned Care
Aims of today Confidence to change practice Confidence to challenge practice
References Adams R (1996) Qualified Nurses lack of knowledge related to oral health Journal of Advanced Bagg J, Jackson M, Sweeney P, Ramage, G, Davies A (2006) Susceptibility to Melaleuca alternifolia (tea tree) oil of yeasts isolated from the mouths of patients with advanced cancer Community Dent Oral Epidemiol. 2005 Apr ;33 (2):115-24 Buglass E A (1995) Oral Hygiene, British Journal of Nursing, 4(9): 516-519 Cooley C (2002) Oral health: basic or essential care? Cancer Nursing Practice 1, 3, 33 – 39 Davies A, Findlay I (2005) Oral Care in advanced disease. Oxford Uni. Press Dodd, M et al (1996) Randomised Clinical Trial of Chlorhexadine Versus Placebo for Prevention of Oral Mucositis in Patients Receiving Chemotherapy. Oncology Nursing Forum, 23(6): 921-927 Eilers, J et al (1998) Development, Testing, and application of the Oral Assessment Guide. Oncology Nursing Forum, 15(3): 325-330.
Ellershaw J, Ward C (2003) Care of the dying patient: the last few hours or days of life. British Medical Journal, 326, 30-34 Evans G (2001) A rationale for oral care Nursing Standard 15, 43, 33-36 Holmes, S, Mountain E (1993) Assessment of oral status: evaluation of three oral assessment guides. Journal Clinical Nursing 2, 35040 Holmes, S. (1996) Nursing Management of oral care in older patients, Nursing Times 92(9):37 39.
Kite, K & Pearson, L (1995) A rationale for mouth care: the integration of theory with practice. Intensive and Critical Care Nursing, 11: 71-76.
Pearson, L S (1996) A Comparison of the Ability of Foam Swabs and Toothbrushes to Remove Dental Plaque: Implications for Nursing Practice, Journal of Advance Nursing, 213:62-69.
Regnard, C et al (1997) Mouth care, skin care, and lymphoedema. BMJ, 18 October, 315, 1002 1005.
Sweeney, P. (1998) Mouth care in nursing – Part 1. Common oral conditions. Journal of Nursing Care, spring, 4-7.
White, R. (2000) Nurse assessment of oral health: a review of practice and education. British