Oral care
Maintenance of oral hygiene and proper oral decontamination play a major
role in the management of patients who present with mucosal injuries.
Microbial colonization of the oral cavity exacerbates the severity of
tissue damage and increases the risk of localized and disseminated
infections. Therefore decontamination may help to reduce the probability
of further complications like secondary infections that may disseminate
into systemic sepsis and also an increase in associated pain. The basic
components of an oral care protocol include assessment, patient
education, tooth brushing and bland oral rinses (normal saline and
sodium bicarbonate). Oral assessment should be conducted regularly to
assess function in terms of ability to feed normally, pain, and the
extent of damage to the oral mucosa. Although oral care has cannot
prevent the formation of paraquat induced oral mucositis, adherence to a
regimen can reduce the duration and severity of mucositis. Three studies
have demonstrated the superiority of using proper oral care after
paraquat ingestion. 16 1718 All the three studies showed a significant decrease
in the severity of symptoms and an improvement in the recovery time.
The first study emphasized the need of early implementation of oral care
in patients with history of paraquat ingestion despite the presence or
lack thereof oral mucosal lesions. 16 The treatment
group received proper oral care at presentation and the control group
received oral care three days after ingestion of paraquat. The study
showed that early oral care at presentation not only reduced the
severity of pain but also decreased the severity of oral mucositis
Bland oral rinses also play an important role in oral care and oral
decontamination; alternatively bland oral rinses can also be used in
combination with other drugs for the preparation of compounded mouth
washes. 19 20 21 22 23Normal saline and sodium
bicarbonate not only aid in the removal of paraquat residue that may be
present in the oral cavity after ingestion but also ensure the removal
of of oral debris like food particles, therefore preventing the
possibility of secondary infections and therefore promoting fast wound
healing. Bland rinses also ensure that the oral cavity is adequately
moisturized, therefore prevent crusting and thus soothing gums and mouth
mucosa therefore increasing patients’ comfort. 1617 18
Oral assessment also plays an important role in evaluating whether the
patients can normally brush their teeth. After assessment, brushing
should be withheld in patients with extensive mucosal injury. Patients
with minimal or localized oral mucosal injury should use soft bristle
brushes and ensure that they brush their teeth gently. Tooth brushing
should be encouraged 2 to 3 times a day or basically after every meal.18 24