Longitudinal changes in oral conditions and oral candidiasis in palliative care inpatients: a longitudinal...

Oral health influences comfort, communication, and quality of life in palliative care. However, its clinical drivers and prognostic significance remain poorly understood. This study examined longitudinal changes in oral conditions over time and identified factors associated with oral deterioration or improvement.

A longitudinal observational study was conducted involving 300 inpatients receiving palliative care. Each patient underwent routine oral assessments using the Oral Health Assessment Tool (OHAT) both before and after oral care. Clinical characteristics, functional status activities of daily living (ADL), number of remaining teeth, oral care frequency, and outcomes at discharge were analyzed.

At baseline, 11.3% of the participants had oral candidiasis, which was associated with poorer oral health assessment scores. Among patients who subsequently died, the prevalence of candidiasis declined significantly after care, while oral health assessment scores worsened, particularly in the "tongue" and "saliva" categories. This paradoxical pattern may suggest a rapid shift in the microbiota immediately preceding death, despite oral care. In contrast, among patients who were discharged alive, candidiasis improved in 81.3% of affected individuals, and oral health assessment scores improved significantly. Post-care oral health assessment scores were influenced by activities of daily living, sex, and the number of remaining teeth. Patients with poorer baseline oral health assessment scores tended to show the greatest improvement, while those with initially better scores often deteriorated, possibly due to reduced care frequency.

In palliative care, oral health is affected by activities of daily living, remaining teeth, sex, and the presence of candidiasis. Rapid intraoral decline near the end of life, coupled with reduced candidiasis, may reflect changes in oral conditions near the end of life; however, because no microbiological analyses were performed, this interpretation remains speculative. Longitudinal evaluation of functional status and oral conditions, potentially enhanced by artificial intelligence-based image analysis, may help clarify prognostic associations rather than provide definitive prognostic accuracy, and could support more tailored oral care.