HealthInfo Waitaha Canterbury
Mouth care in palliative care
This page is about caring for someone in palliative care. If you're caring for someone who is ill but not in palliative care, see Carer's guide to mouth care.
Often people in palliative care need someone to keep their mouth clean because they cannot do it themselves. It's important to do this 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 terminally ill or has a progressive disorder. For example, it can make it difficult for them to eat or drink or to communicate with others.
Provide mouth care
Anyone, including whānau/family and caregivers can perform this mouth care.
If you're caring for someone at the end of their life, providing mouth care can be a very important part of making sure they're comfortable. It can also help to keep you involved in their care.
When you're providing mouth care for someone at the end of their life, do so every two hours – or more often if necessary. It's most important to check for redness, swelling, sores, white patches, bleeding, pain and dryness. Tell their nurse or doctor if there are any changes.
When you're using a swab, make sure you do not 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.
What to have:
- Two to three mouth swabs (oversized cotton buds) or a super soft toothbrush.
- A salt and baking soda mouthwash. Make it with half a teaspoon of salt and half a teaspoon of baking soda, dissolved in 200 ml of water. Make it fresh every day and keep it in the fridge.
- A toothbrush and toothpaste (if the person you're caring for has teeth). Only use 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 (over-sized cotton buds) 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're caring for. For example, you can use:
- cool tea or coffee
- fruit juice
- fizzy drink
- cool, clear soup
- ice cream
- yoghurt.
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. If the person usually drinks a lot of alcohol, swabbing their mouth with alcohol might keep them more settled. 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 your loved one'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 HealthInfo clinical advisers. Endorsed by Canterbury DHB and community palliative care specialists. Last reviewed November 2020.
SourcesReview key: HIPAL-17434
