Clinical Review

ABC of palliative care: Mouth care, skin care, and lymphoedema

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7114.1002 (Published 18 October 1997) Cite this as: BMJ 1997;315:1002
  1. Claud Regnard,
  2. Sarah Allport,
  3. Lydia Stephenson

    Mouth care

    Patients' oral problems can be kept to a minimum by good hydration, brushing the teeth with a fluoride toothpaste twice daily, and daily observation of the oral mucosa. Oral problems can reduce intake of fluid and food because of pain, altered taste, or disorders of swallowing. The first step is to manage the local problems.

    Risk factors for oral problems

    • Debility

    • Dry mouth

    • Chemotherapy

    • Poor oral intake

    • Local irradiation

    • Dehydration

    Infection

    Key questions for mouth care

    • Is infection present?

    • Is the mouth dry?

    • Is the mouth dirty?

    • Is the mouth painful?

    Candidiasis usually presents as adherent white plaques but can also present as erythema or angular cheilitis. Nystatin suspension is the usual treatment, but in advanced disease ketoconazole 200 mg once daily for 5 days is cost effective and more convenient for patients (hepatic toxicity has not been reported for 5 day courses). Fluconazole 150 mg as a single dose is equally effective but is more expensive. Recurrent candidiasis in patients with AIDS requires prophylactic treatment with fluconazole 50 mg daily.

    Oral candidiasis

    Oral hygiene is important, especially daily cleaning of dentures. Aphthous ulcers are common and can be helped by topical corticosteroids or tetracycline mouthwash. Severe viral infection (herpes simplex or zoster) will need aciclovir 200 mg every 4 hours for 5 days. Malignant ulcers are often associated with anaerobic bacteria that produce a foul odour; this responds to metronidazole, either as 400–500 mg taken orally or rectally every 12 hours or as a topically applied gel.

    Dirty mouth

    Local measures for oral problems

    Infected mouth
    • Topical corticosteroids—Betamethasone 0.5 mg in 5 ml water as mouthwash or triamcinolone in carmellose paste

    • Tetracycline mouthwash, 250 mg every 8 hours (contents of one capsule dissolved in 5 ml water)

    Dirty mouth
    • Regular brushing with soft toothbrush and toothpaste

    • Pineapple chunks

    • Cider and soda mouthwash

    Dry mouth
    • Semifrozen tonic water and gin

    • Semifrozen fruit juice

    • Frequent sips of cold water or water sprays

    • Petroleum jelly rubbed …

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