Inspissated oral secretions, more loosely known as dried oral secretions, may seem harmless at first, but, as with most things in our body, too much of anything can be a detrimental to our health. Most of us who have worked in a long term setting have encountered these secretions, but may not be aware of their consequences or how to address them. Basically, these are oral cavity secretions that have thickened and dehydrated. They consist primarily of saliva. However, thickened saliva can accumulate bacterial, fungal, food and other particles that are inspired through the mouth as well as the nose. These can then accumulate on the roof of the mouth, soft palate and even further back in the oral cavity. In some documented cases they can be the cause of airway inhibition.
Saliva has many redeeming properties. It works to lubricate the oral cavity, break down food, provide minerals to the teeth and has antimicrobial effects. Mucins are included in the makeup of saliva. When the more liquid or wet components of saliva are depleted or not well manufactured due to dehydration, the mucinous component serves as a good reservoir for infection and saliva becomes then much harder for the patient to clear. Unfortunately, much of the beneficial properties of saliva can be negated when the secretion is dehydrated.
Occurrence of inspissated secretions is more common in the following instances. For younger patients this would include asthma, severe allergies and cystic fibrosis. For geriatric patients being dehydrated and being constant mouth breathers in general leads to an increase of this condition. Reduced salivary flow is quite common in older adults due to medications. In cases of elders who also are constant mouth breathers, or on ventilators, the likelihood of seeing the buildup of inspissated secretions in the mouth is great. For patients who are tube fed, a decreased salivary flow may occur because little oral stimulation leads to less saliva.
Figure 1 is an example of a patient with this build up of dried secretions. Figure 1: Courtesy of Dr. Linda Niessen If a caregiver has not seen this before it can be shocking and may lead to a request for the evaluation for a suspicious oral lesion. The dried secretions often will not wipe off easily, which adds to the suspicion. To remove them, take a 4×4 gauze that is soaked with warm water to the point of saturation, but not dripping, hold it on the lesion for about 1 minute, and then gently wipe. Do this gently, as the tissue underneath can easily tear, causing longer term discomfort for the patient. Two to three gentle wipes in this fashion will usually clean the mouth well.
Figure 2 (page 7) shows the clean mouth after removal of these inspissated secretions. In order to prevent the recurrence of this build up, patients should be advised to follow a twice daily regimen of gently cleaning the oral cavity by wiping it with warm water and then lubricating the tissue. A gel such as Oralbalance® made by Laclede or even a more generic lubricating jelly such as KY® can be used in the mouth. Some dental practitioners recommend using the 0.12% chlorhexidine rinse to swab the mouth.
This is acceptable, but due to the high alcohol content of the rinse, it can be more drying to the tissue. for that reason, it is desirable to follow this with some lubricating jelly. Providing this level of care should no only afford the patient an increased quality to life, but also possibly a reduction in poor systemic outcomes.
– Gretchen Gibson, DDS, MPH