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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: Nov 2017. | This topic last updated: Jun 23, 2016.
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  1. Aldred MJ, Addy M, Bagg J, Finlay I. Oral health in the terminally ill: a cross-sectional pilot survey. Spec Care Dentist 1991; 11:59.
  2. Wilberg P, Hjermstad MJ, Ottesen S, Herlofson BB. Oral health is an important issue in end-of-life cancer care. Support Care Cancer 2012; 20:3115.
  3. Wiseman M. The treatment of oral problems in the palliative patient. J Can Dent Assoc 2006; 72:453.
  4. Walls AW, Murray ID. Dental care of patients in a hospice. Palliat Med 1993; 7:313.
  5. Fischer DJ, Epstein JB, Yao Y, Wilkie DJ. Oral health conditions affect functional and social activities of terminally ill cancer patients. Support Care Cancer 2014; 22:803.
  6. Chen X, Chen H, Douglas C, et al. Dental treatment intensity in frail older adults in the last year of life. J Am Dent Assoc 2013; 144:1234.
  7. Wiseman M. Palliative care dentistry. In: Geriatric Dentistry: Caring For Our Aging Population, 1st ed, Friedman PK (Ed), John Wiley & Sons, Ames, IA 2014. p.17.
  8. Wilwert M. Should dentists be included as members of the hospice care team? Spec Care Dentist 2003; 23:84.
  9. Strauss RP, Hunt RJ. Understanding the value of teeth to older adults: influences on the quality of life. J Am Dent Assoc 1993; 124:105.
  10. Kayser-Jones J, Bird WF, Paul SM, et al. An instrument to assess the oral health status of nursing home residents. Gerontologist 1995; 35:814.
  11. Australian Department of Health and Ageing. Urbis JHD. Trial of the Draft NAtional Framework for Documenting Care in Residential Aged Care Services. Draft Report, 2004. Published in 2009, and available online at http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442455398 (Accessed on May 26, 2016).
  12. Chalmers JM, King PL, Spencer AJ, et al. The oral health assessment tool--validity and reliability. Aust Dent J 2005; 50:191.
  13. Chalmers J, Johnson V, Tang JH, Titler MG. Evidence-based protocol: oral hygiene care for functionally dependent and cognitively impaired older adults. J Gerontol Nurs 2004; 30:5.
  14. Miller KE, Miller MM, Jolley MR. Challenges in pain management at the end of life. Am Fam Physician 2001; 64:1227.
  15. Lobbezoo F, Weijenberg RA, Scherder EJ. Topical review: orofacial pain in dementia patients. A diagnostic challenge. J Orofac Pain 2011; 25:6.
  16. Herr K, Coyne PJ, Key T, et al. Pain assessment in the nonverbal patient: position statement with clinical practice recommendations. Pain Manag Nurs 2006; 7:44.
  17. Chen X, Clark JJ, Preisser JS, et al. Dental caries in older adults in the last year of life. J Am Geriatr Soc 2013; 61:1345.
  18. Matsuo K, Watanabe R, Kanamori D, et al. Associations between oral complications and days to death in palliative care patients. Support Care Cancer 2016; 24:157.
  19. Potulska A, Friedman A. Controlling sialorrhoea: a review of available treatment options. Expert Opin Pharmacother 2005; 6:1551.
  20. Humphrey SP, Williamson RT. A review of saliva: normal composition, flow, and function. J Prosthet Dent 2001; 85:162.
  21. Pedersen AM, Bardow A, Jensen SB, Nauntofte B. Saliva and gastrointestinal functions of taste, mastication, swallowing and digestion. Oral Dis 2002; 8:117.
  22. Ekström J, Khosravani N, Castagnola M, Messana I. Saliva and the control of its secretion. In: Dysphagia: Diagnosis and Treatment, Ekberg O (Ed), Springer-Verlag, Berlin 2012. p.19.
  23. Davies AN, Broadley K, Beighton D. Xerostomia in patients with advanced cancer. J Pain Symptom Manage 2001; 22:820.
  24. Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. Am Fam Physician 2004; 69:2628.
  25. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.
  26. Akpan A, Morgan R. Oral candidiasis. Postgrad Med J 2002; 78:455.
  27. Budtz-Jørgensen E. Oral mucosal lesions associated with the wearing of removable dentures. J Oral Pathol 1981; 10:65.
  28. Chalmers JM, Wiseman M, Ettinger R, Spector EL. ORal hygiene care for palliative care residents in nursing homes, 2009. Guidelines available online at https://www.healthcare.uiowa.edu/igec/publications/info-connect/assets/oral_hygiene_palliative.pdf (Accessed on May 27, 2016).
  29. Chalmers JM, Wiseman M, Ettinger R, Spector EL. Oral Hygiene Care for Palliative Care Residents in Nursing Homes. In: Center IGE (Ed), 2009. p.1.
  30. Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet 2005; 366:1809.
  31. Scannapieco FA, Shay K. Oral health disparities in older adults: oral bacteria, inflammation, and aspiration pneumonia. Dent Clin North Am 2014; 58:771.
  32. Woo SB, Challacombe SJ. Management of recurrent oral herpes simplex infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103 Suppl:S12.e1.
  33. Balasubramaniam R, Klasser GD. Orofacial pain syndromes: evaluation and management. Med Clin North Am 2014; 98:1385.