Assessment

Scottish Palliative Care Guidelines
Healthcare Improvement Scotland
  • Patients who are receiving or have recently received chemotherapy or radiotherapy need careful monitoring both pre- and post-treatment.
  • Medication history is important as numerous medications can affect the oral environment:
    • opioids, diuretics and anticholinergics increase dry mouth
    • steroids increase the risk of candidiasis
    • bisphosphonates increase the risk of osteonecrosis of the jaw. Ill-fitting dentures and surgical intervention including tooth extraction increase this risk, highlighting the need for preventative oral hygiene therapy.
  • For patients at the end of life, ensure that active routine assessment is carried out.
  • Ensure comfort and minimise pain when carrying out an assessment by lubricating cracked lips with a water-based product.
  • Petroleum lip balms should be avoided due to flammability and aspiration risk.
  • Previous applications of water-based lubricants should be gently removed before replacing.
  • Remove dentures before examining the mouth or performing routine mouth care.
  • Check the lining of the mouth is clean.
  • Look for signs of dryness, coating, ulceration, infection or tooth decay. Assess for pain.
  • Consider dental referral with the patient’s consent for persistent oral symptoms or if it has been more than one year since the patient has been examined by a dentist.