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