1. Palliative medicine & End-of-Life care
requirements for opioid prescription course
Palliative medicine & End-of-Life care

2. Welcome to Module Five: Palliative Medicine and End-of-Life Care
NARRATOR V.O.: Welcome to Module Five: Palliative Medicine and End of Life Care. This module provides an overview of the special considerations for addressing dental pain/oral issues when the treatment goal is to maximize the comfort of the patient (palliative care) and compassionately address end of life oral discomfort or complications.
This module provides an overview of the special considerations for addressing dental pain/oral issues when the treatment goal is to maximize the comfort of the patient (palliative care) and compassionately address end-of-life oral discomfort or complications. 
@ copyright New York State Dental Foundation

3. 
The role of Dentistry
Understanding the Role of Dentistry and the Dental Professional
Managing Pain with Analgesics
Alternative Methods for Managing Pain

4. Understanding the Role of Dentistry
The dentist is a “team member” providing oral care comfort measures to the patient receiving palliative and/or end-of-life care. Comprehensive oral care will contribute to both proper patient health management and comfort/quality of life.
The role of the dentist may include:
Providing or encouraging oral hygiene
Alleviating pain or discomfort
Managing potential oral side effects associated with cancer therapy (e.g., mucositis, candida)
Eliminating site of infection or potential infection
Understanding the patient’s preferences for enhancing oral function
Protecting self-esteem through aesthetic maintenance

5. The Role of Dentistry During a Patient’s Cancer Treatment
Provide post-treatment comfort
Help manage pain through all phases
Listen to the patient in order to gain insight into other concerns that may arise during treatment and offer appropriate referrals to resources
Diagnose and refer for cancer treatment
Provide patient education and preparation for cancer treatment(s)
Address any oral side effects while patient is in treatment

6. Managing Pain with Analgesics
Pain is an “unpleasant sensory and emotional experience.” Reducing the severity of pain and discomfort is the greatest assistance for a patient receiving palliative care. Take time to listen to the patient for the cause of pain or discomfort to determine whether it’s associated with the disease or related to the psychological aspects of cancer.
Note: Any drugs should be prescribed in conjunction with the patient’s palliative or end-of-life managing physician.

7. Alternative Methods for Managing Pain
Alternatives to analgesics may include:
Cognitive therapy
Physical therapy
Acupuncture for regional chronic pain
Hypnosis to modify responses to various stimuli
“Pain clinic” referral
Alternative pharmacologic agents (e.g., tricyclics, anticonvulsants, SNRIs)
Capsaicin
Biofeedback
Transcutaneous nerve stimulation (TENS)
Heat and cryotherapy (used individually or in combination)
Long-term regional anesthesia or block