Oral health problems among palliative and terminally ill patients: an integrated systematic review

Abstract

Background: High incidence of treatable oral conditions has been reported among palliative patients. However, a large proportion of palliative patients lose their ability to communicate their sufferings. Therefore, it may lead to under-reporting of oral conditions among these patients. This review systematically synthesized the published evidence on the presence of oral conditions among palliative patients, the impact, management, and challenges in treating these conditions. Methods: An integrative review was undertaken with defined search strategy from five databases and manual search through key journals and reference list. Studies which focused on oral conditions of palliative patients and published between years 2000 to 2017 were included. Results: Xerostomia, oral candidiasis and dysphagia were the three most common oral conditions among palliative patients, followed by mucositis, orofacial pain, taste change and ulceration. We also found social and functional impact of having certain oral conditions among these patients. In terms of management, complementary therapies such as acupuncture has been used but not well explored. The lack of knowledge among healthcare providers also posed as a challenge in treating oral conditions among palliative patients. Conclusions: This review is first in its kind to systematically synthesize the published evidence regarding the impact, management and challenges in managing oral conditions among palliative patients. Although there is still lack of study investigating palliative oral care among specific group of patients such as patients with dementia, geriatric or pediatric advanced cancer patients, this review has however provided baseline knowledge that may guide health care professionals in palliative settings.

It Takes Two to Tango: How a Dysregulation of the Innate Immunity, Coupled With Candida Virulence, Triggers VVC Onset

“…Candida albicans ( C. albicans ), a member of the endogenous human microbiota, is a dimorphic fungus that dwells in the mucosae of the oropharynx, genital and gastrointestinal tracts of 30–70% of healthy individuals ( Odds, 1987 ; Kauffman, 2006 ; Pappas, 2006 ; Pfaller and Diekema, 2007 ). When the immune system is compromised, Candida can behave as an opportunistic pathogen: it causes oral-pharyngeal infections, especially in AIDS patients, but it is also associated with oral cancer ( Ramla et al, 2016 ), diabetes and it can affect terminally ill patients ( Venkatasalu et al, 2020 ). Interestingly, Candida is also a leading causative agent of vulvovaginal candidiasis (VVC) in healthy women, even though in this pathology the fungus does not behave as a classical opportunistic pathogen, since VVC is not necessarily linked to an immunodeficient state.…”

Factors affecting the oral health of inpatients with advanced cancer in palliative care

“…Debilitation, fatigue, anorexia, pain, and depression are common in patients with terminal-stage cancer [ 6 ]. However, alongside systemic symptoms, patients also often develop various oral health disorders such as dry mouth, candidiasis, dysphagia, mucositis, dysgeusia, ulcers, dental caries, gingivitis, and tongue plaque [ 7 ]. These oral health problems are highly likely to have a major detrimental effect on QOL, both functionally, in terms of mastication, conversation, and eating difficulty, and psychologically, in terms of anxiety and depression [ 8 ].…”

Candidiasis oral

“…Ésta es una de las características clínicas más comunes de los pacientes con VIH, observándose hasta en el 90% de los casos [2]. También, se ha reportado una alta incidencia de afecciones bucales como la candidiasis en pacientes paliativos debido al uso de quimioterapias, y otros fármacos [4]. Este paciente presentó una candidiasis oral pseudomembranosa, diagnosticada mediante su cuadro clínico y micológico; y en base a este se le indicó el tratamiento antifúngico pertinente con una buena respuesta al tratamiento.…”