Case Report
A Case of Oral Ulcer Because of Residual Drug on a Dysphagia Patient
2012 Volume 16 Issue 1 Pages 70-74
Details
2012 Volume 16 Issue 1 Pages 70-74
Oral drug selection is important for patients with dysphagia. We report a case of a patient suffered from an ulcer caused by residual drugs in the oral cavity.
[Case] An 89-year-old female with dementia with a history of hypertension and cerebral infarction was admitted for pneumonia, respiratory insufficiency, and dysphagia. Before admission she used a wheelchair, and had taken a normal diet. After admission she ate mixer-processed dysphagia diet 3 times a day with assistance but sometimes choked. [Course] At 1 month after admission, a nurse reported oral hemorrhage to the dental department. The oral cavity was edentulous and dry. The mucosal color had changed to yellowish green in the right buccal over the sublingual mucosa and the right lips. And ulceration and hemorrhage were noted in the central region.
The cause was unclear at that time, but a dental hygienist continuously performed oral care and the condition improved. However, the same findings were observed in the left buccal over the sublingual mucosa 5 days after oral care initiation. A residual drug (Fero-gradumet tablet®) was found in the region, suggesting ulceration caused by the residual drug. Since no problem was noted on a modified water swallowing test on admission, the respiratory department recommended oral drug ingestion with water after meals. Thus, the dental hygienist requested the nurse to confirm the absence of any residual drug in the mouth after drug ingestion. However, the retention of a drug (Pletaal®) in the palatal region was noted after 2 days. After discussion with nursing staff, the administration method was changed to the ingestion of a jellyembedded drug. No problem occurred thereafter. The ulcer had completely healed with the above oral care after 20 days.
[Discussion] The oral retention of drugs is problematic. Because such residual drugs injure the mucosa, as noted in the present patient, and a necessary amount of the drug is not absorbed. The important role of dental hygienists includes not only oral care, but also the discovery of drugs retained in the oral cavity, as well as the proposal of an appropriate drug administration method.
