Clinical Practice Pearls

Mouth cares have always been an important part of achieving comfort for people at the end of life.

Xerostomia (the feeling of a dry mouth) is very common during the last days of someone’s life and can often cause agitation and a sense of thirst. Poor mouth hygiene is a leading cause of pneumonia and longer hospital admissions.

Xerostomia occurs more often in people with conditions such as cancer, autoimmune diseases and anyone taking medications with a high anticholinergic drug index. These include anticholinergics, opiates, and benzodiazepines and in those people who have received treatments such as chemotherapy and/or radiation.

Candidiasis (Oral Thrush) is also very common in the elderly and frail population particularly post antibiotic treatment, during or after a course of steroids (including inhalers) and during times of stress. Often people can also experience nausea and poor appetite. Pain and difficulty swallowing can also occur with oral thrush.

It is important when people are experiencing a change in their condition or are deteriorating, that an oral assessment is completed.  Using a torch or other light can be helpful when examining someone’s mouth. Remember to remove the dentures to have a good look at the gums and oral mucosa.

For the deteriorating or dying person, mouth cares should be done every 2 hours during personal cares/pressure area cares.

Always offer to show the family and carers how to help with mouth cares. The feeling of being able to do something for their family and whānau can give them a great sense of purpose and feel involved.  Many people fear that someone is thirsty when they can no longer eat and drink. Mouth cares help to prevent that feeling and that fear.

Mouth Cares include:

• Brushing or cleaning teeth at least twice daily.

• Use swab sponges (Dentips) or cotton buds to clean inside of mouth. including cheeks, gums, own teeth, lips.

• Utilise favourite fluids/drink or oral lubricants such as rice bran oil to provide moisture to the oral mucosa.

• Lip balm to the lips to prevent cracking.

• Soak dentures in denture cleaner (i.e., Efferdent, Polident) usually after every meal and overnight.

• Consider Nilstatin drops for oral thrush treatment.