Dental care of patients in a hospice
Identifieur interne : 000D99 ( Istex/Corpus ); précédent : 000D98; suivant : 000E00Dental care of patients in a hospice
Auteurs : Awg Walls ; Id MurraySource :
- Palliative medicine [ 0269-2163 ] ; 1993-10.
English descriptors
- KwdEn :
- Chronic trauma, Cohesive forces, Complete dentures, Dental advice, Dental care, Dental pain, Dental school, Dental status, Dentate, Dentate individuals, Denture, Denture base, Denture hygiene, Denture retention, Distal extension, Early carious lesions, Edentulous, Edentulous individuals, Final patient, Fitting surface, Flow diagram, Great difficulty, Hospice, Maxillofacial surgery, Oral health, Oral mucosa, Oral ulceration, Painful mouth, Palliative care, Paralysed side, Prosthesis, Replacement dentures, Root surface caries, Salivary, Salivary flow, Salivary function, Satisfactory dentures, Soft palate, Symptomatic relief, Ulceration, Weight loss, Xerostomia.
- Teeft :
- Chronic trauma, Cohesive forces, Complete dentures, Dental advice, Dental care, Dental pain, Dental school, Dental status, Dentate, Dentate individuals, Denture, Denture base, Denture hygiene, Denture retention, Distal extension, Early carious lesions, Edentulous, Edentulous individuals, Final patient, Fitting surface, Flow diagram, Great difficulty, Hospice, Maxillofacial surgery, Oral health, Oral mucosa, Oral ulceration, Painful mouth, Palliative care, Paralysed side, Prosthesis, Replacement dentures, Root surface caries, Salivary, Salivary flow, Salivary function, Satisfactory dentures, Soft palate, Symptomatic relief, Ulceration, Weight loss, Xerostomia.
Abstract
This paper describes the dental care provided at an English hospice. Dental care is felt to be important because the ability to enjoy food is an important element in the quality of life. Over a three-year period, 67 patients were referred for dental advice of whom all but four were edentulous. The commonest complaint was of ill-fitting dentures, and the causes and possible solutions to this problem are reviewed.
Url:
DOI: 10.1177/026921639300700409
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ISTEX:1C2A27DF756698F526EE1BF529D2F3B037B05BFALe document en format XML
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Dental care is felt to be important because the ability to enjoy food is an important element in the quality of life. Over a three-year period, 67 patients were referred for dental advice of whom all but four were edentulous. The commonest complaint was of ill-fitting dentures, and the causes and possible solutions to this problem are reviewed.</div></front></TEI><istex><corpusName>sage</corpusName><keywords><teeft><json:string>denture</json:string><json:string>prosthesis</json:string><json:string>xerostomia</json:string><json:string>ulceration</json:string><json:string>denture base</json:string><json:string>dentate</json:string><json:string>dental care</json:string><json:string>hospice</json:string><json:string>dental pain</json:string><json:string>palliative care</json:string><json:string>salivary</json:string><json:string>edentulous</json:string><json:string>replacement dentures</json:string><json:string>soft palate</json:string><json:string>denture retention</json:string><json:string>salivary flow</json:string><json:string>fitting surface</json:string><json:string>oral mucosa</json:string><json:string>symptomatic relief</json:string><json:string>root surface caries</json:string><json:string>oral ulceration</json:string><json:string>flow diagram</json:string><json:string>salivary function</json:string><json:string>great difficulty</json:string><json:string>satisfactory dentures</json:string><json:string>final patient</json:string><json:string>painful mouth</json:string><json:string>early carious lesions</json:string><json:string>dental status</json:string><json:string>complete dentures</json:string><json:string>dentate individuals</json:string><json:string>chronic trauma</json:string><json:string>cohesive forces</json:string><json:string>dental advice</json:string><json:string>weight loss</json:string><json:string>oral health</json:string><json:string>dental school</json:string><json:string>distal extension</json:string><json:string>denture hygiene</json:string><json:string>paralysed side</json:string><json:string>edentulous individuals</json:string><json:string>maxillofacial surgery</json:string></teeft></keywords><author><json:item><name>Awg Walls</name><affiliations><json:string>Department of Restorative Dentistry, The Dental School, Newcastle upon Tyne</json:string></affiliations></json:item><json:item><name>ID Murray</name><affiliations><json:string>Department of Restorative Dentistry, The Dental School, Newcastle upon Tyne</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>dental care</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>denture retention</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>hospices</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>oral health</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>terminal care</value></json:item></subject><articleId><json:string>10.1177_026921639300700409</json:string></articleId><arkIstex>ark:/67375/M70-8BKG65HB-H</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>This paper describes the dental care provided at an English hospice. 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Dental care is felt to be important because the ability to enjoy food is an important element in the quality of life. Over a three-year period, 67 patients were referred for dental advice of whom all but four were edentulous. The commonest complaint was of ill-fitting dentures, and the causes and possible solutions to this problem are reviewed.</p></abstract><textClass><keywords scheme="keyword"><list><head>keywords</head><item><term>dental care</term></item><item><term>denture retention</term></item><item><term>hospices</term></item><item><term>oral health</term></item><item><term>terminal care</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1993-10">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/1C2A27DF756698F526EE1BF529D2F3B037B05BFA/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus sage not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article" dtd-version="2.3" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">sppmj</journal-id><journal-id journal-id-type="publisher-id">PMJ</journal-id><journal-title>Palliative Medicine</journal-title><issn pub-type="ppub">0269-2163</issn><publisher>
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<contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Walls</surname><given-names>Awg</given-names></name><aff>Department of Restorative Dentistry, The Dental School, Newcastle upon Tyne</aff></contrib></contrib-group>
<contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Murray</surname><given-names>ID</given-names></name><aff>Department of Restorative Dentistry, The Dental School, Newcastle upon Tyne</aff></contrib></contrib-group>
<pub-date pub-type="ppub"><month>10</month><year>1993</year></pub-date><volume>7</volume><issue>4</issue><fpage>313</fpage><lpage>321</lpage><abstract><p>This paper describes the dental care provided at an English hospice. Dental care is felt to be important because the ability to enjoy food is an important element in the quality of life. Over a three-year period, 67 patients were referred for dental advice of whom all but four were edentulous. The commonest complaint was of ill-fitting dentures, and the causes and possible solutions to this problem are reviewed.</p></abstract><kwd-group><kwd>dental care</kwd>
<kwd>denture retention</kwd>
<kwd>hospices</kwd>
<kwd>oral health</kwd>
<kwd>terminal care</kwd></kwd-group><custom-meta-wrap><custom-meta xlink:type="simple"><meta-name>sagemeta-type</meta-name><meta-value>Journal Article</meta-value></custom-meta><custom-meta xlink:type="simple"><meta-name>search-text</meta-name><meta-value>313 Dental care of patients in a hospice SAGE Publications, Inc.1993DOI: 10.1177/026921639300700409 Awg Walls Department of Restorative Dentistry, The Dental School, Newcastle upon Tyne ID Murray Department of Restorative Dentistry, The Dental School, Newcastle upon Tyne Address for correspondence: AWG Walls, Department of Restorative Dentistry, The Dental School, Framlington Place, Newcastle upon Tyne NE2 4BW, UK. dental care denture retention hospices oral health terminal care This paper describes the dental care provided at an English hospice. Dental care is felt to be important because the ability to enjoy food is an important element in the quality of life. Over a three-year period, 67 patients were referred for dental advice of whom all but four were edentulous. The commonest complaint was of ill-fitting dentures, and the causes and possible solutions to this problem are reviewed. Mots-cl6s: soins dentaires; retention du dentier; hospices; hygiene buccal; soins en fin de vie Cet article decrit les soins dentaires apport6s dans un hospice anglais. Les soins dentaires sont consid6r6s comme importants parce que la capacltb d'appr6cler la nourriture est un el6ment important de la qualit6 de vie. Sur une p6riode de trois ans, 67 patients ont ete r6f6r6s pour examen dentaire, tous 6tant 6dent6s sauf quatre d'entre eux. Des dentiers mal ajust6s ont fait l'objet des complaintes les plus courantes. Les causes de ce probi6me ainsi que leurs possibles solutions sont examin6es. Introduction Palliative care is concerned with the study and care of patients in whom prognosis is limited and where the focus of care is the quality of life. This care can take many forms, including relief from pain and/or symptoms, companionship and counselling. Care for patients is provided by a combination of qualified medical and nursing staff, as well as a large number of willing volunteers. This paper describes the experiences of two dental practitioners who provide the dental care necessary for patients at St Oswald's Hospice in Newcastle upon Tyne. One factor that can help to improve the quality of life is the ability to enjoy food. This enjoyment can be marred by poor cooking, by an inability to taste, and by an inability to chew food. There are three factors which will interfere with mastication: 1) Reduced salivary flow. This is commonly a result of radiation, or pharmacologically induced xerostomia. 2) A painful mouth. The oral tissues may be damaged by cytotoxic therapy resulting in atrophy and ulceration of the mucosa; there is also an increased susceptibility to oral infection. Both of these phenomena are exacerbated by xerostomia. 3) An inability to chew. This can be a result of dental pain or of ill-fitting dentures. Again, xerostomia can have a key role to play in producing dental pain or poor denture tolerance. 72314 A number of relatively simple procedures are available to help overcome the problems of dental pain and ill-fitting dentures. It is to these problems and their solution that this paper is devoted. Methods All patients who are admitted to the hospice are questioned to see whether they have any perceived problems with their mouth or dentition, and the mouth is examined to check for infection or ulceration. A flow diagram is used to aid the carer in achieving a reliable diagnosis of any problem. If any complaints are received from the patients, or staff are unhappy concerning oral health, specialist dental advice is sought. Problems Over a three-year period a total of 67 patients have been referred for dental advice, all but four of whom were edentulous. The major presenting complaint (Table 1) was of loose dentures. This made mastication more difficult and was sometimes accompanied by mild discomfort as a result of oral ulceration. The four partially dentate individuals had two clinical problems. Two had lost fillings, resulting in dental pain associated with the ingestion of hot, cold and sweet foods. The other two patients had radiation-induced xerostomia2 with the associated problems of thin, sensitive, patchily ulcerated mucosa and root surface caries (Figure 1). The majority of the remaining, edentulous, patients complained of ill-fitting dentures and some also had discomfort when eating. None of the dentures in question had been fabricated recently, consequently it was assumed that the problems associated with the prostheses were not a result of errors in construction. All subjects who complained of discomfort were found to have traumatic ulceration of the denture-bearing area. This was associated with over-extension of the denture base. In a further 15 patients who had not complained of discomfort, areas of ulceration were found around the periphery of the denture-bearing area. Once again, this ulceration was attributable to over-extension of the denture base in the region of the ulcer. In all these cases the perceived over-extension of the denture base was probably a result of alveolar resorption. Four Table 1 Major presenting complaints of patients referred for specialist dental advice D = Partially dentate, E = Edentulous 73315 patients were seen who complained of nausea on also had marked limitation of mouth opening as attempting to place the complete upper denture a result of destruction/fixation of their muscles of in the mouth. The most common cause of nausea mastication and were experiencing some difficulty associated with upper dentures is a result of in attempting to use their previously satisfactory over-extension of the denture base posteriorly dentures as a result of a loss in available space for on to the soft palate, which stimulates the gag the prosthesis. reflex. As none of these patients had recently The final patient complained of roughness of been provided with new dentures and all gave the inner aspect of his lower denture. On exami- a history of satisfactory denture-wearing over a nation a layer of dental calculus some 3 mm thick number of years, inappropriate extension of the was visible as a red/brown layer on the lingual denture base was unlikely to be the cause of surface of the acrylic denture adjacent to the nausea for these subjects. orifices of the submandibular salivary ducts. Three patients complained of discomfort on wearing their dentures, attributed to reduced Solutions salivary function as a result of xerostomia induced The replacement of a lost restoration may seem by radiotherapy in two patients and anticholiner- to be a relatively simple task. However, it is gic drugs in the third. complicated by the need to remove any decay Three patients had a similar problem, with and to keep the tooth reasonably dry during partially masticated food collecting in the buccal the restorative procedure. The availability of sulcus during eating, which caused great difficulty relatively lightweight, portable dental equipment in clearing that area of the mouth. All three had a (Figure 2) has made it possible for the dental facial hemiplegia as a result of destruction of the surgeon to perform simple restorative tasks at facial nerve by an invasive tumour either during the bedside. The result may not be as good as its passage through the petrous temporal bone or could be achieved in a fully equipped surgery, but within the parotid gland. Two of these patients will prevent further sensitivity and the progression Figure 1 Extensive carious lesions in a patient with radiation-induced xerostomia. The carious lesions involve the cervical margins of many of the remaining standing teeth and the incisal edges of the lower incisors. This latter appearance is very uncommon. 74316 of disease. The management of oral discomfort is difficult if there is associated xerostomia. Saliva has an important role in the oral environment, acting to protect and lubricate the oral mucosa, provide a buffer to modify pH changes within the mouth, remineralize any early carious lesions within the teeth, initiate digestion of sugars and to bind the food bolus together to facilitate swallowing. Loss of function is associated with root surface caries, thin sensitive mucosa, and a constant feeling of dry mouth with problems of chewing, tasting food and swallowing (Figure 3). Many xerostomic patients retain some salivary function, albeit at a reduced rate and in altered quality. Attempts at gustatory salivary stimulation may provide some symptomatic relief, but acidic stimulants should be avoided in the partially dentate individual to reduce the risk of decay or acid softening and thence wear of the remaining teeth. Mechanical stimulation of salivary flow, in the form of chewing sugar-free gum, may be of some benefit. Pharmacological induction of salivary secretion with a cholinergic agonist such as pilocarpine is fraught with problems from generalized increase in cholinergic tone throughout the body. Artificial saliva substitutes may also be of use, but those with low pH should be avoided in the partially dentate to avoid tooth surface demineralization. The inclusion of fluoride in the artificial saliva will aid in the remineralization of any early carious lesions that develop in the dentate subject. There are two such products available., Glandosane (Fresenius, based upon sodium carboxymethylcellulose) and Saliva Orthana (Nycomed, based upon pig gastric mucin). Both these products are available from the pharmacist, although there may be religious and moral scruples associated with the use of the latter product which is of porcine origin. One advantage of both of these products is their delivery as a spray which is both simple to use and easy to transport in a pocket or handbag. Ill-fitting dentures are a common problem. Indeed in studies of the dental status of elderly individuals in longstay accommodation, nearly all the residents had dentures, only a small proportion of which were deemed satisfactory.3-5 Even within the healthy adult population the average age of complete dentures is in the region of 15-20 years.6 Complete dentures are supported by the residual alveolar and basal bone of the maxilla and Figure 2 A portable dental unit powered by compressed gas which can be taken to a patient's bedside to provide dental care on a domiciliary basis 75317 mandible, through the overlying alveolar mucosa. The quality of support, stability and retention of dentures depends upon the shape of the remaining bony ridge and the quality of fit of the denture base against the mucosa. Generally, dentures are made from acrylic resin. Their shape is derived from a single snapshot impression of the denture-bearing tissues, which, as has been stated, was commonly recorded some 10-20 years previously. Alveolar bone is a functional matrix, designed to support teeth. Once the teeth are extracted the alveolar bone resorbs progressively with time, producing a reduction in both height and breadth of the residual alveolar ridge. The rate of resorption varies from individual to individual, but often results in dentures which only contact the 'supporting' alveolus at their periphery (Figure 4) as the prostheses age. This has two results. First, excessive forces are placed upon the limited supporting tissues, especially in the lower arch. These forces may result in either ulceration of the alveolar mucosa and/or a chronic inflammatory response resulting in granuloma formation (Figure 5). The ulceration can be extensive and may mimic the appearance of a malignant oral ulcer, although regression is rapid once the source of the chronic trauma is removed by trimming the denture base, or by leaving the denture out of the mouth. Secondly, complete dentures are retained against the alveolus by a number of factors, one of which is a combination of adhesive and cohesive forces between the mucosa, a thin film of saliva and the denture base. If there are large discrepancies between the fit surface of the prosthesis and the alveolus, such forces cannot act. In such a case, the patient controls the position and stability of the denture with habitual movements of the tongue, lips and cheeks against the smooth or polished surfaces of the prosthesis during function. These oral Figure 3 Management options for patients complaining of dry mouth 76318 Figure 4 A cross-section through a 25-year-old lower complete denture superimposed upon an accurate contemporary cast of the supporting tissues. As can be seen the denture only contacts the supporting tissues at the periphery of the denture thus potentially increasing the load on these areas of mucosa and bone. Figure 5 A denture-induced granuloma on the lingual aspect of an atrophic mandibular alveolar ridge caused by chronic trauma to the oral mucosa from a denture which only applied functional load to its periphery as seen in Figure 4. The groove produced by the periphery of the denture can be clearly seen (arrow). 77319 gymnastics are a relatively complicated activity to learn, and are maintained by constant practice. Patients who are undergoing palliative care from a hospice can be very ill, and have often undergone either radiotherapy, chemotherapy, or both. Both these treatments induce nausea and may be associated with a sore mouth. Consequently, it is likely that edentulous subjects will leave their prostheses out of their mouths during this experience. As a result, the pattern of muscular activity involved in achieving denture stability is not reinforced on a daily basis and the patient's denture-wearing skills are reduced. When the dentures are returned to the mouth the patient immediately perceives that they are loose, and may have great difficulty in adapting to their use. It is a common finding that patients associate this perception of a loose prosthesis with weight loss. Whilst there will undoubtedly be some alteration in the alveolar form as a product of weight loss, it is unlikely to be the cause of the marked discrepancies between the shape of the alveolar ridge and contour of the fitting surface of the denture seen in many of these patients. The solution in most cases is to improve the closeness of fit between the denture base and the soft tissues, thus improving the support for the denture and re-establishing the adhesive and cohesive forces involved in denture retention. Usually this can be achieved temporarily at the bedside using a temporary soft lining material (Coe-Soft, Coe Laboratories, Inc., Chicago). These resilient materials permit rapid modification of the denture, and an immediate increase in patient comfort. If appropriate, replacement dentures can be fabricated subsequently, preferably using a denture-copying technique. The objective of this is to duplicate, as closely as possible, the size, shape and inter-arch relationship of the patient's old dentures, whilst improving the quality of fit to facilitate denture retention Whilst some modification to the dentures can be made during this procedure, it is unlikely, in a debilitated subject, that any change would be made to the shape of the polished surfaces of the denture, as it is through this surface that the wearer gains control as a result of oral gymnastics. Nausea associated with previously satisfactory dentures is probably a result of two factors. Many patients have difficulty in tolerating the distal extension of a full upper denture towards the soft palate. This tolerance may be eroded when the patient is debilitated, or if the subject is nauseated as a result of drug therapy. If at the same time the denture is loose, the problem of nausea will be potentiated. In all four patients who complained of nausea, tolerance of their prosthesis was improved by trimming the distal extension of the upper denture away from the vibrating line at the junction of the hard and soft palate. Patients who wear complete dentures and subsequently develop xerostomia often have some difficulty in tolerating their prostheses. Denture retention depends upon the integrity of a salivary film between the denture base and the mucosa. That integrity will be impaired with the reduced salivary flow in xerostomia. In addition, the subject's mucosa will become dry and therefore sensitive to low levels of mechanical trauma, resulting in oral ulceration. The solution is to minimize denture movement by ensuring a good fit and to produce a polished, atraumatic, fitting surface to the dentures. Salivary substitutes or stimulants may also be of benefit, and techniques for the incorporation of a reservoir for the artificial medium within a complete denture have been described.10 In addition, individuals with dry mouths are particularly susceptible to infections of the oral mucosa, and many have relatively high rates of carriage of yeasts, coliforms and staphylococci Meticulous denture hygiene is required in such circumstances. Dentures must be left out of the mouth at night and should be stored in a disinfecting solution (either Milton [5% sodium hypochlorite] or 0.2% Hibitanel2) after the removal of soft debris with a brush, soap and water. Subjects who develop a facial hemiparesis can experience problems with food accumulating in the cheek of the paralysed side. This can be unpleasant as the food debris has to be cleaned out mechanically by the patient or a carer and is a problem with both dentate and edentulous individuals. In addition to this problem, two of the patients seen had significant limitation of opening which made insertion of their original prostheses virtually impossible. Some attempt can be made to surmount these difficulties with the provision of replacement dentures. The replacements can be modified in two ways: firstly, the occlusal 78320 vertical dimension (height) of the prosthesis can be reduced, if there is adequate space between the alveolar ridges; and, secondly, buccal bulges can be added to the dentures on the paralysed side to fill the cheek pouch. This latter technique helps to prevent food impaction into the cheek, and may provide some support for the facial tissue. The final patient who had a rough denture was a victim of his own low standards of denture hygiene. The deposition of calculus on the polished and fitting surface of a denture is relatively uncommon, as the precursors of the mineral deposits are easily removed with a brush and paste or a proprietary denture cleanser. If a patient has a problem with the regular deposition of mineralized deposits, an acidic denture cleanser such as Denclen (Proctor and Gamble, Surrey) will be of some assistance. Discussion - ....= . -. " -....;;;. The number of partially dentate individuals seen during this study was relatively low and probably reflects two factors. First, the majority of elderly people in the UK are edentulous at the present time. However, there is a consistent trend for the rate of edentulousness to fall in all age-groups in this country.13 Consequently, there will be increasing numbers of older patients with some of their natural teeth who will require hospice care in the near future (Figure 6). These patients will bring with them different problems in terms of oral care than the existing cohorts of edentulous individuals, including the need for regular oral hygiene and the potential for tooth decay, pain and related infection. Xerostomia for these patients, whether induced by radiation, drugs or Figure 6 Projections of change in the patterns of edentulousness over the next 40 years.6 The percentage of the over-75-year-old population who retain some teeth is estimated to rise from 20% at the present to 80% by 2034. 79321 simply debilitation, is a major problem. Secondly, patients who are undergoing care in a hospice have concerns other than their dental health. Referral would probably only occur if the patient complained of pain from their mouth. It is of interest that the opioids commonly used during palliative care are relatively poor at providing relief from pain of dental origin.14 An antiinflammatory analgesic is likely to be more effective. Summary Discomfort associated with painful teeth, a sore mouth, or ill-fitting dentures are a source of morbidity amongst patients undergoing palliative care. Symptomatic relief can often be obtained using relatively simple bedside techniques to improve the quality of life for these patients. References Regnard CF, Fitton S. Mouth care: a flow diagram. Palliatve Med 1989; 3: 76-79. Mira JG, Fullerton GD, Wescott WB Correlation between initial salivary flow rate and radiation dose in the production of xerostomia. Acta Radiologica et Oncologica 1982; 21: 151-54. Manderson RD , Ettinger RL Dental status of the institutionalised elderly population of Edinburgh. Community Dent Oral Epidemiol 1975; 3: 100-107. Jobbins J., Bagg J., Finlay JG, Addy M., Newcombe RG Oral and dental disease in terminally ill cancer patients. Br Med J 1992; 304: 1612. Lapeer GL The dentist as a member of the palliative care team. J Can Red Cross 1990; 56: 205-207. Todd JR, Lader D. Adult dental health 1988. London: HMSO, 1991: 151-54. Murray ID, Wolland AW New dentures for old. Dent Pract 1986; 24: 1-6. Davenport JC , Heath JR The copy technique. Br Dent J 1983; 155: 162-63. Duthie N., Lyon F., Sturrock KC, Yemm R. A copying technique for replacement dentures. Br Dent J 1978; 144: 248-52. Vissink A., Jong HP, de Busscher HJ et al. Intra-oral artificial saliva reservoirs in the management of patients suffering from severe xerostomia. In: Hjorting Hansen E ed. Oral and maxillofacial surgery. Proceedings from the 8th international conference on oral and maxillofacial surgery. Chicago: Quintessence, 1985: 5/14-5/17. Jobbins J., Bagg J., Parsons G. et al. Oral carriage of yeasts, coliforms and staphylococci in patients with advanced malignant disease. J Oral Pathol Med 1992; 21: 305-308. Guggisberg E., Rapin C-H., Budtz-Jorgensen E. Care of the mouth in the elderly - experience at the Centre de Soins Continus. J Palliative Care 1990; 1: 21-23. Todd JE, Lader D. Adult dental health 1988. 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</ref-list></back></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Dental care of patients in a hospice</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Dental care of patients in a hospice</title></titleInfo><name type="personal"><namePart type="given">Awg</namePart><namePart type="family">Walls</namePart><affiliation>Department of Restorative Dentistry, The Dental School, Newcastle upon Tyne</affiliation></name><name type="personal"><namePart type="given">ID</namePart><namePart type="family">Murray</namePart><affiliation>Department of Restorative Dentistry, The Dental School, Newcastle upon Tyne</affiliation></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>Sage Publications</publisher><place><placeTerm type="text">Sage CA: Thousand Oaks, CA</placeTerm></place><dateIssued encoding="w3cdtf">1993-10</dateIssued><copyrightDate encoding="w3cdtf">1993</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract lang="en">This paper describes the dental care provided at an English hospice. Dental care is felt to be important because the ability to enjoy food is an important element in the quality of life. Over a three-year period, 67 patients were referred for dental advice of whom all but four were edentulous. The commonest complaint was of ill-fitting dentures, and the causes and possible solutions to this problem are reviewed.</abstract><subject><genre>keywords</genre><topic>dental care</topic><topic>denture retention</topic><topic>hospices</topic><topic>oral health</topic><topic>terminal care</topic></subject><relatedItem type="host"><titleInfo><title>Palliative medicine</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><identifier type="ISSN">0269-2163</identifier><identifier type="eISSN">1477-030X</identifier><identifier type="PublisherID">PMJ</identifier><identifier type="PublisherID-hwp">sppmj</identifier><part><date>1993</date><detail type="volume"><caption>vol.</caption><number>7</number></detail><detail type="issue"><caption>no.</caption><number>4</number></detail><extent unit="pages"><start>313</start><end>321</end></extent></part></relatedItem><identifier type="istex">1C2A27DF756698F526EE1BF529D2F3B037B05BFA</identifier><identifier type="ark">ark:/67375/M70-8BKG65HB-H</identifier><identifier type="DOI">10.1177/026921639300700409</identifier><identifier type="ArticleID">10.1177_026921639300700409</identifier><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-0J1N7DQT-B">sage</recordContentSource></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/1C2A27DF756698F526EE1BF529D2F3B037B05BFA/metadata/json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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