HealthInfo Canterbury
Carer's guide to mouth care
This page is about caring for someone who is ill, but not terminally ill. If you are caring for someone who is terminally ill, see Mouth care in palliative care.
When people can't keep their mouths clean and clear, such as when they are very ill, or have a progressive neurological disorder, they need someone to do this for them. It's important, because it reduces the risk of infections in their mouth.
A healthy mouth has an intact 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 or drink, or to communicate with others.
Anyone, including whānau/family and caregivers, can perform this mouth care.
How to give mouth care
When you are providing mouth care for someone, it's most important to look inside their mouth once a day to look for redness, swelling, sores, white patches, bleeding, pain, or dryness. Tell their nurse or doctor if there are any changes.
Mouth care should happen after every meal or snack. If the person is not allowed to eat (nil by mouth, or NBM), carry out mouth care every two hours, or even more often if needed.
When you are using a swab, make sure you don't poke it too far back on the person's tongue, as this may make them gag.
Cleaning the person's mouth
Before you start make sure the person is sitting up, or lying on their side – this protects their airway.
Make sure you have:
- two to three mouth swabs or a super soft toothbrush
- mouthwash solution (the nurse or pharmacist will advise you what to use).
- toothbrush and toothpaste (if the person you are caring for has teeth). Use only a pea-sized amount of toothpaste, and no water, to minimise the amount of foam and increase the cleaning action of the toothpaste.
What to do:
- 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 their mouth.
Clean each area of the mouth with a new swab until it comes out looking clean. Areas to clean are:
- top gum
- bottom gum
- roof of mouth
- under tongue
- surface of tongue
- inside of cheeks.
Dry mouth
Having a dry mouth can be very uncomfortable. If the person you're caring for is too unwell to keep their mouth moist, you can use swabs dipped in water, or whatever fluid they like, to moisten their mouth and lips every one to two hours.
The type of fluid you use is not as important as the act of moistening their mouth. Use fluids that are familiar to the person you are caring for. For example, you can use:
- water, cool tea or coffee, milk, cool, clear soup, ice cream, yoghurt
- oral moisturisers available from your pharmacy
- coconut oil
- one drop of peppermint essence to 100 mL of grapeseed oil. Apply a drop or two to the person's mouth when it starts to get dry.
If the person is drowsy or unconscious, familiar fluids and the touch of a family member can lessen the shock of having something placed in their mouth. Avoid iced water, as this can be a shock, especially if someone has sensitive teeth.
Take particular care if their mouth is painful or has ulcers. Consider using choline salicylate gel (Bonjela), which you can buy from a supermarket or pharmacy. Make sure you keep their lips moist with petroleum jelly (Vaseline) or lip salves.
Sore mouth
If the person's tongue becomes sore, red, or covered with a fuzzy coating they may have oral thrush (candida). Tell their doctor, as this is easy to treat with antifungal drops. Regularly cleaning and moistening their mouth can help to prevent this.
Written by community speech-language therapists, Canterbury DHB. Adapted by HealthInfo clinical advisers. Last reviewed October 2020.
Sources
Review key: HISWD-121957
