**7. Oral care palliative care protocol**

At the beginning of oral care, a facial massage of the masseter muscle and salivary glands. An oral moisture jelly and moisture spray were utilized for enhancing mucosal moisture and for protecting the mucosa. Also, a soft dental brush was used to remove plaque and debris on the teeth. Then, oral foam sticks were utilized for mucosa cleansing [110].

Palliative treatment for squamous cell carcinoma treatment included monochemotherapy with the administration of cetuximab. The side effects of cetuximab are manageable. The common reactions are mostly cutaneous, with the appearance of acne, dryness, itching, and peeling on the skin [111]. Corticosteroids such as prednisone are usually administrated with the cetuximab treatment to minimize the previously mentioned adverse effects. Nonetheless, the repeated use of this medication may cause other disturbances, such as osteoporosis [112].
