*2.4.11 Further Care in Cleaning the teeth: when flossing is a challenge*

Daily brushing, flossing, and rinsing are three of the most important steps to having healthy teeth and gums. Yet, debilitated patients may have trouble wrapping floss around the fingers or in keeping a steady hand. They may also be intolerant to a caregiver's putting two fingers far back into the mouth.

There are a few methods that may make interdental cleaning easier. The patient or caregiver can use floss picks to clean under gums and in-between the teeth,

**77**

basin.

*Why Are We Missing the Teeth? Addressing Oral Care Neglect in the Palliative Patient*

where plaque and food work their way under the gingiva every day and can lead to

Other options include soft picks (thin, feathery, rubber toothpicks), and various floss folders, all of which can be used with one hand by the patient. For caregivers, it is easier to reach the back of the mouth by using a long-handled floss aid, a thin instrument shaped rather like a slingshot, across which floss can be threaded.

Flossing (or the closest semblance thereof) is necessary in accessing areas under the gums where a toothbrush cannot reach. It is important to brush after meals and

The use of dentures is common in the hospice population of patients. Numerous

Atrophy of facial muscles in stroke or advanced head and neck cancer patients can contribute to the inability for dentures to stay in properly. Looseness of the denture can also be brought about by significant weight loss or from resorption over

Various treatments being administered for palliative care patients can exacerbate sores in the mouth, causing a patient distress while wearing the denture, even when

Discontinuation of denture-wearing is acceptable, if the dentures are providing less benefit than they are in creating discomfort and frustration for the patient. Usually, the hospice patient can maintain his same level of nourishment after discontinuing the use of his dentures by changing the textures of foods eaten and by

If the patient in fact is distressed while wearing his dentures, but is also having trouble functioning without them, a dental professional should examine the den-

Oral Hygiene Plan of Care for the Edentulous Patient With or Without Dentures

• Remember that dentures are not necessary for proper eating, communicating,

• Dentures should be labeled on the inside with the patient's name written using

tures for sore spots, poor fit, need for reline, and the like, as is possible.

an indelible marker or placed within the acrylic by a professional.

• Dentures should be removed and safely set aside while cleaning the teeth.

• Dentures should be brushed with a toothbrush and toothpaste low in a sink or

• Oral care should be provided after meals and as is necessary.

• Caregivers should wash hands and wear gloves.

• Clean the grooved areas of dentures with the brush.

*Water jet irrigation devices are not generally recommended for hospice patients.*

*2.4.12 Care of Full Denture Patients (and when is it okay not to wear dentures any* 

studies involving long-term care facilities show that, while many patients have dentures, a small proportion of these dentures are actually worn, because of issues with comfort and function. This proportion is likely higher in palliative care patients because of comorbidities, including xerostomia (dryness), Candidiasis,

*DOI: http://dx.doi.org/10.5772/intechopen.95606*

to floss at least before bedtime each day.

and general physiologic debilitations and losses.

previous years of the bony architecture underneath the denture.

gum disease.

*longer?)*

not eating or talking with it.

eating/being fed more slowly.

and other such functions.

*Why Are We Missing the Teeth? Addressing Oral Care Neglect in the Palliative Patient DOI: http://dx.doi.org/10.5772/intechopen.95606*

where plaque and food work their way under the gingiva every day and can lead to gum disease.

Other options include soft picks (thin, feathery, rubber toothpicks), and various floss folders, all of which can be used with one hand by the patient. For caregivers, it is easier to reach the back of the mouth by using a long-handled floss aid, a thin instrument shaped rather like a slingshot, across which floss can be threaded.

Flossing (or the closest semblance thereof) is necessary in accessing areas under the gums where a toothbrush cannot reach. It is important to brush after meals and to floss at least before bedtime each day.

*Water jet irrigation devices are not generally recommended for hospice patients.*

*2.4.12 Care of Full Denture Patients (and when is it okay not to wear dentures any longer?)*

The use of dentures is common in the hospice population of patients. Numerous studies involving long-term care facilities show that, while many patients have dentures, a small proportion of these dentures are actually worn, because of issues with comfort and function. This proportion is likely higher in palliative care patients because of comorbidities, including xerostomia (dryness), Candidiasis, and general physiologic debilitations and losses.

Atrophy of facial muscles in stroke or advanced head and neck cancer patients can contribute to the inability for dentures to stay in properly. Looseness of the denture can also be brought about by significant weight loss or from resorption over previous years of the bony architecture underneath the denture.

Various treatments being administered for palliative care patients can exacerbate sores in the mouth, causing a patient distress while wearing the denture, even when not eating or talking with it.

Discontinuation of denture-wearing is acceptable, if the dentures are providing less benefit than they are in creating discomfort and frustration for the patient. Usually, the hospice patient can maintain his same level of nourishment after discontinuing the use of his dentures by changing the textures of foods eaten and by eating/being fed more slowly.

If the patient in fact is distressed while wearing his dentures, but is also having trouble functioning without them, a dental professional should examine the dentures for sore spots, poor fit, need for reline, and the like, as is possible.

Oral Hygiene Plan of Care for the Edentulous Patient With or Without Dentures


*Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care*

• Gums that have receded or pulled away from the teeth

Adequately maintained oral care can alleviate this disease's progression and

• Dentures should be removed and soaked/brushed separately, low and over a

• A soft toothbrush or oral sponge should be angled against the gumline, gently

• Use toothpaste slurry or coconut oil for brushing, avoiding harsh or burning types of toothpastes, such as those with sodium laurel sulfate, mint, or

Discontinuation of denture-wearing is acceptable, if they are providing less benefit than they are creating discomfort and frustration for the patient. Usually, the hospice patient can maintain his same level of nourishment after discontinuing the use of his complete or partial dentures by changing the textures of foods eaten

If the patient in fact is distressed while wearing his dentures, but is also having trouble functioning without them, a dental professional should examine the den-

Daily brushing, flossing, and rinsing are three of the most important steps to having healthy teeth and gums. Yet, debilitated patients may have trouble wrapping floss around the fingers or in keeping a steady hand. They may also be intolerant to

There are a few methods that may make interdental cleaning easier. The patient

or caregiver can use floss picks to clean under gums and in-between the teeth,

tures for sore spots, poor fit, need for reline, and the like, as is possible.

*2.4.11 Further Care in Cleaning the teeth: when flossing is a challenge*

a caregiver's putting two fingers far back into the mouth.

*2.4.10 Care of partial denture patients (and when is it okay not to wear the* 

Independent mouth care for those with teeth or partial dentures:

brushing teeth and an up-and-down motion with short strokes.

• Purulence (pus) between the gums and the teeth

• Movement or displacement of permanent teeth

• Caregivers should wash hands and wear gloves.

• Apply lip moisturizer consistently as is necessary.

• Gums that bleed when brushed

• Halitosis (bad breath)

*partials any longer?)*

• Brush the patient's tongue.

and by eating/being fed more slowly.

symptomatology.

sink or basin.

cinnamon.

• Gums that are red, swollen, or tender

**76**

