Oral care, and the cancer Oral care, and the cancer patient.patient.

Emma RileyEmma Riley

Macmillan Oral Health PractitionerMacmillan Oral Health Practitioner

The Pennine Acute TrustThe Pennine Acute Trust

““The compartmentalization involved in viewing the mouth The compartmentalization involved in viewing the mouth separately from the rest of the body must cease because separately from the rest of the body must cease because oral health affects general health by causing considerable oral health affects general health by causing considerable pain and suffering and by changing what people eat, their pain and suffering and by changing what people eat, their

speech and their quality of life and well beingspeech and their quality of life and well being

Oral health affects people physically and Oral health affects people physically and psychologically and influences how they grow, psychologically and influences how they grow, enjoy life, look, speak, chew, taste food and enjoy life, look, speak, chew, taste food and socialize, as well as their feelings of social socialize, as well as their feelings of social

well-being”well-being”Sheiham, Aubrey, Bulletin of World Health Sheiham, Aubrey, Bulletin of World Health

Organisation 2005Organisation 2005

Much of the literature suggests that nurses are Much of the literature suggests that nurses are unsure about oral care.unsure about oral care.

More worryingly some do not regard it More worryingly some do not regard it as priority.as priority.

““It’s just a dry mouth”It’s just a dry mouth”

Trouble eating and Trouble eating and speaking.speaking.

Increased risk of oral Increased risk of oral fungal infections and fungal infections and periodontal disease.periodontal disease.

Increased risk of Increased risk of dental caries and dental caries and missing teeth.missing teeth.

Helping the symptomsHelping the symptoms

Acknowledge that there is a Acknowledge that there is a problem, don’t just see it as problem, don’t just see it as “par for the course”“par for the course”

Maintain good oral hygiene.Maintain good oral hygiene.

Try one of the various Try one of the various products available.products available.

Reassess to see if there Reassess to see if there has been any has been any improvement.improvement.

““Your mouth might get a little sore”Your mouth might get a little sore”

Can lead to severe pain, Can lead to severe pain, which impacts on patients which impacts on patients ability to speak, eat and ability to speak, eat and drink.drink.

Increased risk of fungal Increased risk of fungal infections.infections.

Patients may need to be Patients may need to be enteral fed.enteral fed.

May have unplanned May have unplanned breaks in treatment due breaks in treatment due to mouth.to mouth.

Oral mucositis, pre warned and Oral mucositis, pre warned and pre- armed.pre- armed.

Inform the patient fully of the Inform the patient fully of the effects of oral mucositis.effects of oral mucositis.

Stress the importance of Stress the importance of good oral hygiene.good oral hygiene.

Assess mouth prior to Assess mouth prior to treatment.treatment.

Offer products to help with Offer products to help with symptoms.symptoms.

Grade the mouth and Grade the mouth and reassess regularly.reassess regularly.

Head and Neck CancersHead and Neck CancersPatient views and experiences.Patient views and experiences.

The National Cancer Alliance January 2002The National Cancer Alliance January 2002 One respondent said she had found out by chance that One respondent said she had found out by chance that she would have ulcers as a side effect of the treatment.she would have ulcers as a side effect of the treatment.

One respondent suffered from the radiotherapy One respondent suffered from the radiotherapy treatment, she contacted her GP and radiotherapy dept treatment, she contacted her GP and radiotherapy dept and they were unable to help. She resorted to contacting and they were unable to help. She resorted to contacting

a network of moutha network of mouth cancer patients for advicecancer patients for advice..

One patient was warned that as a result of One patient was warned that as a result of his radiotherapy treatment he would lose his his radiotherapy treatment he would lose his

sense of taste for a time, he said that this sense of taste for a time, he said that this still did not prepare him for how strange this still did not prepare him for how strange this

was:was:

““I’ll tell you what; they never I’ll tell you what; they never prepare you for it. It is the weirdest prepare you for it. It is the weirdest thing in the world and it’s horrible. I thing in the world and it’s horrible. I couldn’t have anything, no food, it’s couldn’t have anything, no food, it’s

horrible”horrible” Tonsil cancer patient Tonsil cancer patient

““Because of my dry mouth I have no Because of my dry mouth I have no quality of life. I can’t enjoy any meals and quality of life. I can’t enjoy any meals and

I have no social life now. I sometimes I have no social life now. I sometimes

wish they hadn’t treated me”wish they hadn’t treated me”

A 37 year old patient who was A 37 year old patient who was treated with Chemo/Radiotherapy treated with Chemo/Radiotherapy for a Nasopharyngeal Carcinomafor a Nasopharyngeal Carcinoma

Alan’s mouth post head and neck cancer Alan’s mouth post head and neck cancer treatment.treatment.

No saliva due to No saliva due to radiotherapy treatment.radiotherapy treatment.Has no tongue so PEG Has no tongue so PEG fed.fed.Patient and wife Patient and wife discharged home with a discharged home with a suction machine.suction machine.Wife removing crusty Wife removing crusty plugs with eye brow plugs with eye brow tweezers.tweezers.Odour from the cavity Odour from the cavity makes social interaction makes social interaction impossible.impossible.

Alan’s mouth when lubricatedAlan’s mouth when lubricated..

Patients wife shown how Patients wife shown how to clean mouth weekly on to clean mouth weekly on a nurse led clinic.a nurse led clinic.

By keeping mouth moist By keeping mouth moist the crusty plugs lift off the crusty plugs lift off easier.easier.

Decreased chest Decreased chest infections.infections.

Odour now gone! Quality Odour now gone! Quality of life greatly improved.of life greatly improved.

Whether elderly, young, oncology each and Whether elderly, young, oncology each and every patient is entitled to a clean, moist and every patient is entitled to a clean, moist and

pain free mouth.pain free mouth.

This is a basic need.This is a basic need.