Aroma-oral care study in palliative care (part 2)

Methods of application of AWMs as addition to regular oral care included:

  1. AWM being sprayed on to oral care sponge and applied onto clean oral cavity 2 times a day, in the morning and evening, or
  2. AWM being sprayed after regular oral care and additionally during the day (3 to 5 times a day).

In total, 24 senior patients (12 male, 12 female) participated in the study. The patients tested range from age 46 to 95 with an average age of 74. All patients are in palliative care. 13 (4 male, 9 female) used the original AWM, 10 of which added AWM to their daily oral care routine twice a day (first method) and other 3 participants applied AWM 3 to 5 times a day (second method). 2 patients chose an aromatic water mixture of winter savory and laurel leaf in equal parts applied via the first method instead. 7 patients chose a single winter savory hydrolat and 2 sage hydrolat. More detail is provided in the chart below.

Legend

  • AWM 1 – original AWM using the first method
  • AWM 2 – original AWM using the second method
  • WL 1 – aromatic water mixture of winter savory and laurel leaf using the first method
  • WL 2 – aromatic water mixture of winter savory and laurel leaf using the second method
  • W 1 – single winter savory hydrolat using the first method
  • W 2 – single winter savory hydrolat using the second method
  • S 1 – single sage hydrolat using the first method
  • S 2 – single sage hydrolat using the second method

General oral concerns of the patients included: dry mouth and mouth mucosa, foul breath and taste, lining the mouth and poor tongue colour, bleeding gums and lips, mouth ulcers, trouble swallowing, pain and inflammation in the mouth, oral candida, poor appetite. All 24 patients had dry mouth mucosa, foul breath, lining the mouth and poor tongue colour.

To examine the effect of hydrolats after application, the medical staff supervising the patients noted study cases and follow up reports as well as filled out a qualitative questionnaire at the end of the monitoring period. The questionnaire included qualitative results on mouth mucosa, foul breath, lining the mouth and tongue colour. If the medical staff noticed other relevant concerns such as bad taste in the mouth, mouth ulcers, pain and inflammation in the mouth at the beginning of monitoring period, those were graded and included in the report as well. Patients’ preferences to the taste and smell were categorised into following categories:

  • likes it
  • reminds of food
  • got used to it
  • dislikes it
  • no reaction.

The medical staff monitoring the patients reported any contraindications as well as unpredicted results, concerns, comments and satisfaction on the results.

The analysis was made based on the reported scores.

Results using only the original AWM

The most significant effects of complimenting regular oral care in palliative patients selected AWM with the lining the mouth and colour of the tongue. 12 out of 13 patients (92%) had less lining the mouth and better tongue colour as shown in before and after picture. Insert photo before and photo after here.

Before

After

The next significant difference was in the quality of breath. 9 out of 13 patients (69%) experienced noticeably better breath and in 5 cases (38%) halitosis has completely disappeared. 5 out of 13 (38%) reported good results in resolving the dry mouth condition and 7 of all (53%) reported that the oral mucosa has become more hydrated. I would like to point out, that 1 facility (i.e. 6 out of 13 study participants) did not report monitoring the results regarding the level of mucosa moisture the reason behind the lower level of AWMs’ effectiveness than expected. Other included facilities (i.e. 7 study participants) reported increased level of moist mucosa as one of the most significant results.

Other relevant improvements the medical staff noticed include fewer mouth ulcers (3 cases), less inflammation in the mouth (3 cases), reduction of Candida Albicans (1 case) and in 1 case the bleeding of the gums and mouth stopped completely.
In regards to the taste, 8 out of 13 (62%) patients liked the original AWM, 1 disliked it, 3 got used to it and 1 had no reaction. 11 patients switched to using a single hydrolat or another AWM. We did not observe any significant changes in appetite or taste.

Furthermore, 8 patients liked the smell of original AWM, 4 had no reaction and 2 couldn’t talk.

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Melani Kovač
aromatherapist, educator

Photography credits:
Petra Jenko, Home for elderly care DEOS, Center starejših Črnuče
https://www.deos.si/crnuce/


Acknowledgements
Andreja Stefan Bukovic, Ana Simenc, Darja Noc, Maja Krzisnik, Mojca Tuljak and Petra Jenko for their research and cooperation with this study. Stjepko Curin (PTO Curin), Jana Bergant (Histria Botanica) for donating hydrolats and Petra Sedej (Aromazen) for donating spray bottles. Maja Pecenic for her advice in the writing of this article.

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