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Palliative care: Overview of mouth care at the end of life

Nathaniel S Treister, DMD, DMSc
Alessandro Villa, DDS, PhD, MPH
Lisa Thompson, DMD
Section Editor
Eduardo Bruera, MD
Deputy Editor
Diane MF Savarese, MD


Palliative care is an interdisciplinary medical specialty that focuses on preventing and relieving suffering and on supporting the best possible quality of life for patients and their families facing serious illness. Palliative care aims to relieve suffering in all stages of disease and is not limited to end of life care. A major tenet of palliative care is early identification, assessment, and treatment of pain and other sources of physical, psychological, emotional, and spiritual distress. Depending on the specific problem or complication, specialists, including dentists, may function as essential members of the interdisciplinary team. (See "Benefits, services, and models of subspecialty palliative care".)

Patients at the end of life are susceptible to a range of oral complications including pain, salivary gland dysfunction, dysphagia, and oromucosal infections [1,2]. Swallowing disorders may lead to aspiration pneumonia, which can directly contribute to mortality. This topic provides an overview of the importance of oral health in patients at the end of life, and the diagnosis and management of common oral complications. A more extensive discussion of swallowing disorders in palliative care patients is provided elsewhere, as is mucositis/stomatitis related to cancer treatment. (See "Swallowing disorders and aspiration in palliative care: Definition, consequences, pathophysiology, and etiology" and "Swallowing disorders and aspiration in palliative care: Assessment and strategies for management" and "Oral toxicity associated with chemotherapy" and "Management and prevention of complications during initial treatment of head and neck cancer", section on 'Mucositis'.)


The oral cavity is often the first site of manifestation of treatment-related side effects in terminally ill patients, or it may be compromised by the direct and indirect effects of progressive, advanced disease [3,4]. Oral health is essential for carrying out activities of daily living (ADLs) such as communication, eating, speaking, and swallowing. Oral complications that can arise in terminally ill patients can impact quality of life (QOL) and contribute to functional decline and failure to thrive [5]. Oral health care is therefore an integral component of palliative care, with the goals of preventing oral complications, maintaining adequate oral function, and optimizing QOL and comfort [6].

Oral health impacts a person’s dignity as well as oral function:

Dignity and respect – While easily overlooked, a patient’s concerns with facial and oral esthetics may relate to his or her desire to die with dignity and respect. As oral health is often neglected at the end of life [6], usual oral hygiene practices may be forgotten or eliminated, and this can contribute to gingivitis and/or periodontitis, caries development, tooth loss, and halitosis. This can impact self-esteem. Additionally, family and friends may avoid contact with their loved one due to halitosis, worsening the patient's isolation and depression [3,7].


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Literature review current through: Sep 2016. | This topic last updated: Jun 23, 2016.
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