Oral Care

Abstract

Adequate dental and oral hygiene may become a challenge for all users and especially for elderly people and young children because of their limited motor skills. The same holds true for patients undergoing/recovering from chemo-/radiotherapy with accompanying sensitive mucosal conditions. Poor dental hygiene can result in tooth decay, gingivitis, periodontitis, tooth loss, bad breath (halitosis), fungal infection and gum diseases. The use of a toothbrush is the most important measure for oral hygiene. Toothbrushes with soft bristles operated carefully by hand or via an electric device help to remove plaque and to avoid mucosal trauma. A handlebar with a grip cover can be helpful for manually disabled patients or for those with reduced motor skills. In case of oral hygiene at the bedside or of patients during/after chemo-/radiotherapy a gauze pad can be helpful for gently cleaning the teeth, gums and tongue. The use of fluoride toothpaste is imperative for the daily oral hygiene. Detergents such as sodium lauryl sulphate improve the cleaning action but may also dehydrate and irritate the mucous membrane. The use of products containing detergents and flavouring agents (peppermint, menthol, cinnamon) should therefore be avoided by bedridden patients or those with dry mouth and sensitive mucosa. Aids for suitable interdental cleaning, such as dental floss, interdental brushes or dental sticks, are often complicated to operate. Their correct use should be instructed by healthcare professionals. To support dental care, additional fluoridation with a fluoride gel or rinse can be useful. Products further containing antiseptics such as chlorhexidine or triclosan reduce the quantity of bacteria in the mouth. For patients undergoing or having undergone radio-/chemotherapy, a mouthwash that concomitantly moisturizes the oral mucosa is advisable.

Antiseptic mouthwashes could worsen xerostomia in patients taking polypharmacy

“…Mucin-rich saliva moistens the oral mucosal surfaces more efficiently than the salivary flows produced during meals by the parotid, submandibular and sublingual glands. Salivary mucins are glycoproteins with large oligosaccharides side chains able to sequester water and lubricate the oral mucosa [11]. They contribute to the extracellular matrix of the oral biofilm [24].…”

“…Treatment protocols may include: general and local hydration, saliva substitutes and lubricants, central (pilocarpine, cevimeline) and local (sugar-free chewing-gums and candies) secretagogues, antifungal treatment, topical analgesics before meals, suppression or replacement of xerogenic drugs, dietary modification and/or dietary supplements and oral hygiene reinforced with antiseptic oral care products. No treatment or combination treatment is fully satisfactory in combating xerostomia [1,2,[11][12][13].…”

Human osteoblast damage after antiseptic treatment

“…Chlorhexidine (2-4 %) can be applied for surgical-site and skin preparation, coating of central venous catheters and for hand disinfection [15]. Significant continuity by the slow release from hard or soft oral tissues has also been observed ensuring prolonged antimicrobial activity following application [16][17][18][19]. In contrast to polyhexanide, povidone iodide, hydrogen peroxide and chlorhexidine do not lose full antiseptic activity in the presence of blood or other liquids [15,20].…”

Criteria for the choice of manual pediatric toothbrush

“…По данным исследований, в большинстве случаев во время чистки зубов удаляется лишь 50% налета [49,91]. По мнению авторов [43], адекватная гигиена ПР может стать проблемой для человека любого возраста, но осо-бенно -для пожилых людей и маленьких детей из-за их ограниченных двигательных навыков.…”