Carer's guide to mouth care Tā te kaimanaaki aratakinga ki te tiakitanga ā-waha
If a person cannot keep their mouth clean and clear, they need someone to do this for them. This may be because they are very ill or have a progressive neurological disorder such as Parkinson's disease or dementia. Mouth care is important because it reduces the risk of infections in their mouth.
An unhealthy mouth in someone who is ill
A healthy mouth has an unbroken lining and is clean, moist and pain-free.
An unhealthy mouth can be very sore, dry or infected. It can have a huge impact on the quality of life of someone who is unwell or has a progressive disorder. For example, it can make it difficult for them to eat, drink or communicate with others.
How to give mouth care
When you are providing mouth care for someone, it is important to look inside their mouth once a day. Anyone, including whānau and caregivers, can perform this mouth care.
You should check the cheeks, top of the tongue and under the tongue, roof of the mouth and the gums around the teeth. You should look for:
- redness
- swelling
- sores or white patches (ulcers)
- bleeding
- pain
- dryness.
Tell their healthcare provider if there are any changes. Sores (ulcers) that do not heal within 3 weeks need to be seen by the person's healthcare provider.
Mouth care should happen after every meal or snack. Sometimes food can stay the mouth after eating and sit in the cheeks and against the teeth. This could cause choking. If it is not cleaned away it can lead to tooth decay.
If the person is not allowed to eat (nil by mouth, or NBM), carry out mouth care every 2 hours, or more often if needed.
Cleaning the person's mouth
Before you start, make sure the person is sitting up and slightly forward, or lying on their side. This helps keep their airway open, so they can breathe.
Make sure you have:
- 2 or 3 mouth swabs or a supersoft toothbrush
- mouthwash solution (the nurse or pharmacist will tell you what to use)
- a toothbrush and toothpaste (if the person you are caring for has teeth).
If the person has teeth, use a soft toothbrush along the outside, top and inside surfaces of the teeth.
Only use a pea-sized amount of toothpaste and no water. This reduces the amount of foam and helps clean the teeth better. Do not rinse the mouth after cleaning as the fluoride in the toothpaste protects the teeth.
Dentures need to be brushed and soaked in denture solution overnight.
How to use a swab
When you are using a swab, make sure you do not poke it too far back on their tongue, as this may make them gag.
- Dip the swab in mouthwash.
- Squeeze excess fluid from the swab.
- Wipe one area of the mouth with the swab.
- Throw away the used swab.
- Repeat in the next area of the mouth.
Clean each area of the mouth with a new swab until it comes out looking clean. Areas to clean are:
- the top gum
- the bottom gum
- the roof of the mouth
- under the tongue
- the surface of the tongue
- inside the cheeks.
Dry mouth
Having a dry mouth can be very uncomfortable. The person you are caring for may be too unwell to keep their mouth moist. If so, you can use swabs dipped in water to moisten their mouth and lips every 1 to 2 hours.
Water is safe to use — even if the person breathes some into their lungs, it will not cause an infection. There is a risk of an infection if you use other fluids.
You can also use oral lubricants. These are available from your pharmacy as a gel, lozenge, mouth spray or wash.
If the person is drowsy or unconscious, having something placed in their mouth can be a shock.
Take particular care if their mouth is painful or has ulcers. Consider using choline salicylate mouth ulcer gel (Bonjela). You can buy this from a supermarket or pharmacy. Make sure you keep their lips moist with petroleum jelly (Vaseline) or non-flavoured lip balms.
Sore mouth
If the person's tongue becomes sore, red or covered with a fuzzy coating, they may have oral thrush (candida). Tell their healthcare provider, as this is easy to treat with antifungal drops. Regularly cleaning and moistening their mouth can help to prevent this.