Oral Care: Hygiene, Checks, and Importance

• Oral care for residents includes the care of:
• Natural teeth and soft tissue
• Dentures
• Only soft tissue (no teeth)
• Residents who do not cooperate

Importance of Oral Hygiene

• Oral care is a very important comfort measure for elderly residents.
• Oral pain from cavities, abscesses, and gum disease is rated as high as childbirth.
• Elderly residents are often unable to verbalize pain or discomfort.
• Residents are three times more likely to develop pneumonia, stroke, and heart disease from plaque-forming bacteria entering the lungs and blood.

Oral Check

• Use a tongue depressor or toothbrush and a penlight if available.
• In an oral check, look for:
• Lumps, swelling, or sores on the face, lips, neck, and mouth
• White patches on the tongue
• Bleeding
• Red swollen gums
• Dry mouth
• Visible plaque and food debris
• Ask the resident if they have any concerns, pain, or trouble swallowing.
• Assess dentures for cracks, missing teeth, or if they are too loose or tight.

Care of Natural Teeth and Soft Tissue

• Supplies include a soft toothbrush, cup with water, gloves, toothpaste, lip moisturizer, alcohol-free mouthwash, and kidney basin.
• Procedure:
• Follow medical asepsis
• Position resident in high fowlers
• Perform an oral check
• Moisten toothbrush
• Sweep out food, if any
• Rinse brush
• Apply a pea-sized amount of toothpaste
• Place toothbrush at a 45-degree angle to the gum line and massage back-and-forth on all teeth
• Take two minutes total, thirty seconds each quadrant
• Brush tongue sides, cheek sides, and chewing surfaces of teeth
• Brush gums and palate
• Finish by rolling toothbrush forward on the tongue
• Ask resident to rinse mouth or use rinsed toothbrush if the resident is unable
• Floss as needed
• Apply lip moisturizer
• The procedure should be done at least twice a day

Care of Dentures

• Supplies include a soft toothbrush, denture brush, denture adhesive as needed, gloves, denture cup, liquid hand soap, kidney basin or cup, and lip moisturizer.
• Procedure:
• Follow medical asepsis.
• Remove dentures and place in kidney basin.
• Dentures are slippery when wet, handle with care, they are expensive.
• Take dentures to the sink lined with a paper towel.
• Brush dentures using a denture brush or a toothbrush, water, liquid hand soap and rinse well.
• Hot water warps dentures and toothpaste scratches them.
• Place in the denture cup.
• Store dentures in a dry, clean container.
• Encourage removal at night or at least 30 minutes a day to promote soft tissue health.
• Continue with soft tissue care of tongue, cheeks and palate with a soft toothbrush dipped in warm water or mouthwash.
• Apply lip moisturizer.

Oral Care for the Resident that Does Not Cooperate

• Supplies include a soft toothbrush, warm water, gloves, alcohol-free mouthwash, salivary substitute or enzymatic gel to inhibit bacterial growth, and lip moisturizer.
• Procedure:
• Apply mouthwash to toothbrush and assist resident and place it in their mouth.
• Turn and wiggle the toothbrush as much as possible.
• Apply a generous amount of salivary substitute gel on the resident's lips with the assumption some will enter the mouth to increase salivary production and inhibit bacterial growth.

End of Life Oral Care Information

• Should be performed at least every two hours or as needed.
• Position resident in the side lying position.
• Follow the same procedure as for the resident that does not cooperate.
• Use minimal fluid on the toothbrush to prevent aspiration.
• Preventing a dry mouth promotes comfort.

Key Points

• Your mouth IS connected to your body
• Gum disease and tooth decay are bacterial infections.
• Provide oral care at least twice daily with a soft toothbrush.
• Insure soft tissue care is provided for residents with dentures.
• For residents unable to cooperate, insure an enzymatic mouthwash and/or salivary substitute are used to break down and inhibit bacterial growth.
• Store dentures in a clean dry area.
• Lip moisturizing is an important final step to quality oral care.