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Table 4 Studies addressing the management of oral conditions among palliative patients

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

Oral conditionStudyManagementEffectiveness
XerostomiaMercadante et al.Drug medication
• Opioids
• Corticosteroids
• Diuretics
• Benzodiazepines
• Anticonvulsants
• Neuropletics
• Nonsteroidal anti-inflammatory drugs
Medical treatment
• Chlorexidine
• antifungal drugs
• Benzydamine
• Natural agents
n/a
Kvalheim et al.Lubricating lips
• Eucerin liniment
• Glycerol
• Vaseline
• Blisex
• Lypsyl
• Lip stick
• Lip cream
Lubricating mucosa
• Glycerol
• Glycerol solution 17%
• Glycerol solution 50%
• Glycerol solution 70%
• Glycerol with peppermint oil
• Glycerol and Chlorhexidine
• Xylocaine/Lidocaine viscous
• Xylocaine/Lidocaine viscous
• Paracetamol mixture and cream
• Panodil mixture and cream 1:1
• Pure cream
• Zendium saliva
• Zendium gel
• Groundnut oil
• Saliva gel
• Oralbalance
• Mouth moisturiser
n/a
Meidell & RasmussenAcupuncture treatment twice a week for 5 weeks – a total of ten treatments.Measurements were using visual analogue scale (VAS), consisted of a horizontal line, 0–10 cm, where 0 represented no problem or discomfort and 10 represented severe problems and discomfort. The feeling of dryness of the mouth declined for all the participants as the series of treatment proceeded. In most cases a substantial improvement could not be noted until after fifth treatments. VAS decreased from 7.5 to 4.8 after fifth treatments (P < 0.001). Between the sixth and tenth treatments, the VAS decreased from 4.8 to 3.3 (P < 0.001). The VAS decreased from 7.5 before the baseline to 3.3 before the tenth treatment (P < 0.001).
 NakajimaStandard oral care by nursing staff of the wards, which include moisturizing, brushing, and oral cleaning (such as tongue coating removal) or oral massage performed by ward staff on a regular basis to resolve dry mouth).
Intervention by specialist oral care team (specialist oral care) was performed as needed.
The rate of dry mouth improvement by oral care intervention was investigated by the severity (Grade 1, 2 and 3).
All grade 1 cases were improved by standard oral care (100%). Grade 2 dry mouth was improved by standard oral care in 85% in good oral intake group (oral food intake was 30% or more) and 71% in poor oral intake group (oral food intake was less than 30%). Six ineffective cases of poor oral intake group were treated with specialist oral care, resulting in an improvement rate of 83%.
Grade 3 dry mouth was improved by standard oral care in 40% in good oral intake group, and 2 ineffective cases were treated with specialist oral care, resulting in an improvement rate of 80%. In poor oral intake group, improvement was achieved by standard oral care in 67%, and 8 ineffective cases were treated with specialist oral care, resulting in an improvement rate of 81%.
Thus, these interventions improved dry mouth in 80% or more
of the patients both in good oral intake group and in poor oral
intake group.
CandidiasisLagman et al.A single-dose fluconazole 150 mg via mouthMajority had complete response, except 2 who did not respond to treatment. Probable side effects of the medication included nausea in 4 patients, abdominal pain in 1, and diarrhea in 1. Both the change in the number of symptoms and the symptom scores before and after treatment decreased significantly (P < 0.001).
Gligorov et al.Local antifungal treatments were prescribed in 123 (75%) patients. Amphotericin B mouthwashes were administered in 67 (54.5%) patients, miconazole mucoadhesive buccal tablet in 36 patients (29.3%), and nystatin mouthwashes
in 20 (16.3%) patients. Fluconazole, an oral systemic treatment, was prescribed in 41 (25%) patients at a dosage of 50 mg/day, 100 mg/day, and 200 mg/day in 7 (17.7%), 22 (53.7%), and 10 (24.4%) patients, respectively. Concomitant non-antifungal treatments were prescribed in 57 (35%) patients, mainly sodium bicarbonate mouthwashes in 45 patients.
Miconazole MBT was reported to be “efficacious”
or “very efficacious” in 25 of 32 patients (78.1%) vs. 39 of 51 (76.5%) for amphotericin B, and 9 of 15 60%)
for nystatin. The nonefficacy reported by the patients was related to noncompliance to treatment; 30% of noncompliant patients vs. 14.3% of those compliant rated amphotericin B as “slightly efficacious or not efficacious.”
DysphagiaMeidell & RasmussenAcupuncture treatment twice a week for 5 weeks – a total of ten treatments.Measurements were using visual analogue scale (VAS), consisted of a horizontal line, 0–10 cm, where 0 represented no problem or discomfort and 10 represented severe problems and discomfort. A substantial improvement of dysphagia was
not obvious until after fifth treatments when the
VAS had decreased from 5.6 to 4.1 (P < 0.001). Between the sixth and tenth treatments, the VAS decreased from 4.1 to 3.7 (P = 0.81). The VAS decreased from 5.6 before the baseline to 3.7 before the tenth treatment (P = 0.01).
Ling & LarssonStep-based pharmacological intervention
1. Acetaminophen
2. NSAID
3. Opioids
4. Adjuvant medication
- Amitryptilin, gabapentin, or pregabalin were considered due to neurotic pain, mainly tumor-related.
- Betametasone was considered for optimized anti-inflammatory effect, impaired general condition, or antiemetic effect.
Topically acting drugs
- Lidocain and benzydamine were prescribed at RT start by the dental services at the hospital to all patients with an irradiated mouth.
Soreness in the mouth showed unexpectedly significant worsening (P = 0.001) between baseline (TQ1) and 1 week later (TQ2).
Significant worsening was found for three swallowing questions about liquids (P = 0.007) and solid food (P = 0.004), choking when swallowing (P = 0.018).
MucositisLing & LarssonStep-based pharmacological intervention
1.Acetaminophen
2.NSAID
3.Opioids
4.Adjuvant medication
- Amitryptilin, gabapentin, or pregabalin were considered due to neurotic pain, mainly tumor-related.
- Betametasone was considered for optimized anti-inflammatory effect, impaired general condition, or antiemetic effect.
Topically acting drugs
Lidocain and benzydamine were prescribed at RT start by the dental services at the hospital to all patients with an irradiated mouth.
Four oral mucositis (OM) grades were used:
0: No reaction
1: Hyperaemia, impressions, soreness, edema
2: Erythema, occasional ulcers, soreness
3: Painful erythema, larger fibrin-coated ulcers
4: Widespread ulcerated areas, easily bleeding, very painful
In the early intervention (EI) group, the OM grade increased between baseline (TQ1) and 1 week later (TQ2) (P < 0.001). In the late intervention (LI) group, the OM grade was unchanged between TQ1 and TQ2 (P = 0.059).
Momo et al.Indomethacin (IM) oral spray (OS)Pain relief was achieved in 93% patients at 25 (5–60) min after applying the IM-OS preparation (15.6 ± 3.4 μg/kg) and analgesic effects were maintained for 120 (10–360) min. The pain was significantly decreased after using the spray (3.6 ± 0.7 vs. 2.4 ± 0.9, p < 0.01). Moreover, urinary IM excretion rates after applying the IM spray preparation were 1.8 ± 0.8% of the IM oral spray dose (130.5 ± 77.7 μg/kg/day), which was markedly lower than that following oral administration of IM (60%). No adverse events were observed following application of the spray.
  1. *n/a not available