Taking care of the oral health of palliative care patients comes with a unique set of challenges, as difficulties with oral hygiene, infections, dry mouth, tumors, vomiting, issues with dentures, and oral thrush are very common in the final stages of life. Unfortunately, a lack of palliative care dentistry and bad breath often go hand in hand. The problem often goes beyond the individual patient and becomes a barrier for social interaction.
“Patients who are in the hospital sometimes have very bad breath,” says dentist Terje Persson. “In some cases the smell from the patient’s mouth is so pungent that neither the family nor the hospital staff wants to have physical contact with the person. And that’s a shame, because hugs and affection are really important when you are sick, hurting, and upset and worried.”
Whereas some patients are embarrassed of their bad breath, others have gotten so used to it that they no longer notice it. And due to the social stigma that is still attached to bad breath, they are not likely to find out from other people. “I think a lot of times even hospital staff are afraid to tell their patients that they have bad breath. It’s perceived as a violation of somebody’s personal integrity,” Perssson says.
Bad breath usually originates in the oral cavity and is caused by bacteria that produce volatile sulfur compounds (VSCs) when they break down lingering food particles in the mouth. In healthy persons, the saliva helps get rid of food debris and control the amount of bacteria and fungus in the mouth. However, end-of-life patients often have dry mouth (xerostomia), which allows the bacteria to colonize and cause bad breath. Sipping on water frequently and using saliva substitutes can help alleviate bad breath caused by dry mouth.
Palliative care dentistry is often neglected, but good mouth care is important for the patient’s comfort, self-esteem, ability to communicate, socialize and enjoy food and drinks. Persson thinks patients should receive a thorough cleaning of the oral cavity on a daily basis. In addition to regular toothbrushing and flossing, applying a fluoridated mouthwash, such as CB12, with a swab can help prevent bad breath in very ill patients. CB12 protects against tooth decay and chemically binds the VSCs that cause bad breath using a combination of zinc acetate and chlorhexidine. “CB12 is a good product,” says Persson. “I use it for my sick patients. I let them rinse once a day, in the morning, and then their breath stays fresh for several hours. If they have severe problems I let them rinse more often.”