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Background: Oral disease is highly prevalent in persons receiving palliative care (PRPC). Yet, little is known about how PRPC perceive their oral health status and related treatment needs. Methods: This mixed-method study included 49 English-speaking PRPC (age≥18) recruited from the University of Iowa Palliative Care Clinic. Participants first completed a structured review of oral symptoms, followed by an oral exam. A nested sample of 11 participants also completed a semi-structured, in-depth interview querying their perceived oral health concerns and related treatment needs. Quantitative and qualitative data was analyzed and integrated for interpretation. Results: Participants averaged 58.4 years. Nearly 70% had terminal cancer and 25% had advanced organ failure. Eighty-six percent of participants reported at least one oral symptom, including dry mouth (83.7%), a pain-related symptom (40.8%), or oral function difficulties (51.0%). Among the 31 dentate participants, 52% had untreated decayed/broken teeth and 33.3% had oral soft tissue lesions. Ill-fitting dentures and denture sores were common among denture users. About 40% of participants reported compromised health and/or quality of life due to oral conditions; however, the perceived impacts were modest. With the exception of painful conditions, oral treatment was not a priority for most of the participants. Conclusion: Oral disease was highly prevalent in PRPC, yet its overall impact was modest. In the absence of painful symptoms, most participants reported limited desire to seek treatment for oral health conditions. However, given the serious impacts of untreated oral diseases, oral healthcare decision should not be based solely on self-reported symptoms or distress.

Individuals with dementia increasingly rely on caregivers for daily oral care over time. This study explored the experience of family caregivers of community-dwelling individuals with dementia in providing oral care and their interest in caregiver oral education using the concepts of Social Cognitive Theory. Twenty-three caregivers ages 19-80 participated in a semi-structured qualitative interview that also included a structured questionnaire. Majority of caregivers were female (83%) with an average age of 56 years; 29% were spouses. Fifty-four percent of care recipients had natural teeth only, 42% had teeth and dentures, and 4% had dentures only. Caregivers were generally knowledgeable about the importance of oral health, but some expressed a lack of knowledge in how to perform oral care for others. Caregivers reported high levels of outcome expectation, agreeing that providing oral care would improve care recipient’s oral health. Caregivers expressed mixed levels of self-efficacy; many cited reduced self-efficacy due to resistance or refusal of care. Quantitative data showed that higher confidence in knowledge and oral care skills was associated with greater confidence in providing oral care (r=0.726, p<0.001). Intent to participate in a caregiver oral health education program was associated with positive outcome expectations (r=0.73, p=0.007) and desire to learn the signs and symptoms of mouth pain and infection (r=0.72, p=0.009). Increasing family caregiver’s oral health knowledge and skills, outcome expectations, and self-efficacy to provide care may help improve the oral health of persons with dementia. Additional qualitative and quantitative data and implications for practice will be presented.

Mishandling medications is commonly seen in persons with dementia, which can lead to poor treatment outcome and serious complications. Whether individuals with cognitive impairment can appropriately manage dental-related medication remains unknown, raising a liability concern for dentists who fail to recognize the patients at risk for mishandling their medications. To address this concern, we conducted a study with 51 participants with various cognitive impairment to describe their ability to handle dental-related medications. After cognitive assessment, participants were asked to set up an antibiotics pill-box and use a mouthwash as instructed, and their performance were scored. Number and type of prompts given to facilitate task completion were also documented. Mishandling of dental-related medications was common in participants with cognitive impairment. As expected, participants with poor cognition needed more assistance on handling their medications. Dentists should be aware of this concern and take it into consideration when treatment plan for these individuals. Part of a symposium sponsored by the Oral Health Interest Group.

Oral disease is highly prevalent in persons receiving palliative care (PRPC). Yet, little is known about how PRPC perceive their oral health status and related treatment needs. Forty-nine PRPC were recruited. They first completed a structured oral symptom review, followed by an oral exam. A nested sample of 11 participants also completed an in-depth interview querying their perceived oral health concerns and related treatment needs. Quantitative and qualitative data was analyzed and integrated for interpretation. Eighty-six percent of participants reported at least one oral symptom, including dry mouth (83.7%), a pain-related symptom (40.8%), or oral function difficulties (51.0%). About 40% of participants reported compromised quality of life due to oral conditions; however, the perceived impacts and treatment needs were modest. Oral disease was highly prevalent in PRPC, yet its overall impact was modest. Except for painful symptoms, most participants reported limited desire to seek treatment for oral health conditions.