Chapter 9: Patient comfort and supporting personal hygiene
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Related theory
The World Health Organization defines oral health as consisting of an oral cavity that is free from tooth decay; tooth loss; disease and disorders, such as birth defects (cleft lip and palate); chronic mouth and facial pain; oral and throat cancer; and oral sores (WHO [240]). Mouth care is an integral and essential part of personal care (NHS HEE [82]). Good oral hygiene is essential, as poor oral health can have a profound impact on the individual, affecting their ability to eat or taste food and to communicate; it can also lead to pain and/or infection, and in some cases life‐threatening illness (Jablonski [92]). Knowledge and attitudes of caregivers are integral to the delivery of effective oral care. Oral health is often seen as a low priority, and issues relating to the intimacy of having another person working inside one's mouth can compound ineffective mouth care (Croyère et al. [44]).
Dental decay
Dental decay begins with the formation of a biofilm known as plaque, which is made up of sugar, bacteria and other debris on the teeth. Tooth enamel can be damaged due to bacterial action, resulting in a drop in pH around the tooth. Once there is damage to the enamel, the inner dentine can also decay (Ozdemir [172]). Areas of decay in teeth are known as caries. Plaque can be physically removed by brushing and flossing teeth. If it is not regularly removed, it can harden to form calculus (tartar), which requires dental treatment for removal. Calculus can also disrupt the seal between the gingiva and the tooth, resulting in red, swollen and bleeding gums (gingivitis). This inflammation can progress to the formation of deep pockets of infection, damaging the teeth and underlying bone (periodontitis) (Marieb and Keller [117]). Smoking is known to be a risk factor for periodontitis; other factors include xerostomia.
Xerostomia
Xerostomia is the subjective sensation of a dry mouth; it is not always correlated with a reduction in saliva production (Anil et al. [8]). It can be associated with thickened saliva or discomfort, which may be burning in nature, leading to difficulty eating or speaking. The prevalence of xerostomia increases with age, and it can be caused by dehydration, systemic health conditions, certain medications and treatments (Anil et al. [8], NHS HEE [82]).
Where possible, the cause should be treated; sips of water normally only relieve the problem briefly. Viscous solutions and gels such as Caphosol or Xerotin should be considered to moisten and protect the mucosa (UKOMiC [234]) (see also the section below on artificial saliva). Production of saliva may be stimulated by the use of sugar‐free chewing gum but acidic sweets should be avoided as they increase the risk of dental caries (NICE [158]). Salivary stimulants such as pilocarpine can be useful (NICE [158]). Studies have also demonstrated that acupuncture may be helpful (Homb et al. [87], RD‐UK [196]).
Patients with xerostomia must pay careful attention to oral hygiene regimes and require good education about mouth care and the associated risks of xerostomia. Xerostomia can cause difficulty in chewing and swallowing food, putting the patient at increased risk of choking as well as oral complications such as caries and periodontitis due to loss of the protective effect of saliva (Plemons et al. [186]).
