Oral care, and the cancer patient. Emma Riley Macmillan Oral Health Practitioner The Pennine Acute Trust

“ The compartmentalization involved in viewing the mouth separately from the rest of the body must cease because oral health affects general health by causing considerable pain and suffering and by changing what people eat, their speech and their quality of life and well being Oral health affects people physically and psychologically and influences how they grow, enjoy life, look, speak, chew, taste food and socialize, as well as their feelings of social well-being” Sheiham, Aubrey, Bulletin of World Health Organisation 2005

Much of the literature suggests that nurses are unsure about oral care. More worryingly some do not regard it as priority.

“It’s just a dry mouth” Trouble eating and speaking. Increased risk of oral fungal infections and periodontal disease. Increased risk of dental caries and missing teeth.

Helping the symptoms  Acknowledge that there is a problem, don’t just see it as “par for the course”  Maintain good oral hygiene.  Try one of the various products available.  Reassess to see if there has been any improvement.

“Your mouth might get a little sore” Can lead to severe pain, which impacts on patients ability to speak, eat and drink. Increased risk of fungal infections. Patients may need to be enteral fed. May have unplanned breaks in treatment due to mouth.

Oral mucositis, pre warned and pre- armed.  Inform the patient fully of the effects of oral mucositis.  Stress the importance of good oral hygiene.  Assess mouth prior to treatment.  Offer products to help with symptoms.  Grade the mouth and reassess regularly.

Head and Neck Cancers Patient views and experiences. The National Cancer Alliance January 2002 One respondent said she had found out by chance that she would have ulcers as a side effect of the treatment. One respondent suffered from the radiotherapy treatment, she contacted her GP and radiotherapy dept and they were unable to help. She resorted to contacting a network of mouth cancer patients for advice.

One patient was warned that as a result of his radiotherapy treatment he would lose his sense of taste for a time, he said that this still did not prepare him for how strange this was: “I’ll tell you what; they never prepare you for it. It is the weirdest thing in the world and it’s horrible. I couldn’t have anything, no food, it’s horrible” Tonsil cancer patient

“Because of my dry mouth I have no quality of life. I can’t enjoy any meals and I have no social life now. I sometimes wish they hadn’t treated me” A 37 year old patient who was treated with Chemo/Radiotherapy for a Nasopharyngeal Carcinoma

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

Alan’s mouth when lubricated. Patients wife shown how to clean mouth weekly on a nurse led clinic. By keeping mouth moist the crusty plugs lift off easier. Decreased chest infections. Odour now gone! Quality of life greatly improved.

Whether elderly, young, oncology each and every patient is entitled to a clean, moist and pain free mouth. This is a basic need.