2020 Volume 40 Issue 4 Pages 485-492
In order to determine the frequency of oral care for bedridden elderly patients who easily form membranous substances, we clarified the formation process of membranous substances on the palate in relation to time and the time required for oral care. Among the elderly requiring long-term tube feeding, 17 patients who were diagnosed with first-degree or more of the clinical diagnostic criteria（Kakinoki）for xerostomia were investigated. Age, disease, nutrition intake（central parenteral nutrition, tube feeding）, and bedridden degree（Ministry of Health, Labor and Welfare in 1991）were examined from hospitalization records. The level of awareness（Japan Coma Scale）, the presence or absence of communication, the possibility of speech, and the frequency of nurses assisting with oral hygiene focusing on membrane care were also examined. The membranous substances on the palate were observed and collected at 3, 6, 12, 24, and 48 hours after dental brushing and mucosal care were performed by dentists. When deposits included epithelial components, HE sections prepared by ordinary procedures were pathologically diagnosed as “exfoliated epithelial membrane”. They were observed pathologically to assess the presence of the epithelial component and to measure the percentage of the epithelial area. Those in which the epithelial component was observed were diagnosed as membranous substances, and the formation state of membranous substances was classified into four categories of “none”, “mucus substances”, “viscous substances” and “dry membranous substances”. The oral care time by dental hygienist or dentist was measured. The median epithelial area ratio of “dry membranous substances” was the largest（84.2%）, the second largest area was “viscous substances”（45.0%）, and the least was “mucus substances”（0%）. A significant difference was recognized for each. At 3 hours after mucosal care, 52.9% of patients were observed to have “mucus substances”. After 6 and 12 hours, 35.3% of patients had “viscous substances”. Those observed with “dry membranous substances” were 11.8% after 6 hours, 23.5% after 12 hours, 47.1% after 24 hours, and 52.9% after 48 hours. The median formation time of “dry membranous substances” was 12 hours, “viscous substances” was 6 hours, and “mucus substances” was 3 hours. The formation time of “dry membranous substances” and “viscous substances” was found to be significantly longer than that of “mucus substances”. It was judged that it is appropriate to perform oral care once every 6 to 12 hours for elderly patients requiring long-term nutrition with tube feeding.
