Overview
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The care of  the patient's mouth is an important element in nursing care. It entails brushing the teeth, flossing between them, and checking the inside of the mouth and gums.  It also include cleaning the dentures if the patient has them. 

The mouth may become dry due to high fever, vomiting or lack of fluid intake. Mouth care helps to stimulate the flow of saliva which prevents it from becoming sore. Keeping the patient mouth clean, moist and free from infection is important in the prevention of dental problems. Cleaning the teeth regularly helps to remove plaque and debris which cause tooth decay and bad breath.  Good oral hygiene may also help to increase appetite.  Mouth care should be performed at least in the morning and at bedtime.  Cleaning or rinsing the mouth after meals should be done when possible.

If you have any questions or concerns about daily mouth care or notice any unusual symptoms in your patient, please consult your healthcare professional.

Tips on Mouth Care

• Eat a well-balanced, and low-sugar diet.

• Encourage high fluid intake, if the patient is not under any fluid restriction, to keep his mouth fresh.

• Eat citrus fruits (eg. oranges), unless this is against medical advice, as these stimulate the production of saliva which naturally cleanse the mouth.

• If the patient's mouth is dry, and he is on restricted fluids, sugar-free chewing gum may encourage the natural flow of saliva and helps to keep his mouth moist.

• Breathe through the nose because mouth breathing makes the mouth dry.

• Observe and routinely inspect the oral mucosa for signs of complications.  Please refer to Signs of Trouble.

• Brush teeth every morning, after meals, and at bedtime.

• Patient who wear dentures should rinse the mouth and dentures after meals.

• Have well-fitting dentures.

Overcoming Physical Disabilities
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For patient who find it difficult to handle toothbrush, you may improvise by enlarging a toothbrush handle with wrapping tape or inserting it into a rubber ball or a bicycle grip handle.  Do consult your dentist about investing in a battery-operated toothbrush (easier for some people to manage) and other specialty products.

Signs of Trouble:

Brushing Teeth in Bed
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If the patient is unable to get out of bed, but can be propped up and is conscious and alert, you can help by bringing the equipment he needs to the bed.  Let him help as much as he can.  Items required include a soft bristles toothbrush, toothpaste, a glass of water, a small bowl or dish to spit into, a towel and tissues to wipe the mouth.

• Help the patient  to a sitting position.

• Cover his chest and shoulders with a towel to keep his clothes and bed from getting wet.

• Allow the patient to brush his own teeth and provide assistance when necessary.

• If the patient is wearing dentures, remove them and wash them separately. Please refer to Care of Denture and Mouth.

• If the patient cannot hold the toothbrush, assist him in brushing his teeth:

 

• Wet the toothbrush and put a small amount of toothpaste on it.

• Place the brush at a 45-degree angle to the gum line and gently brush the outside of the upper teeth downward from the gum line. Brush the bottom teeth upward from the gum line.

• Use short and gentle strokes to prevent gum damage.

• Brush the chewing part of the bottom and top teeth using a back and forth motion.

• Use the front tip of the toothbrush to brush the insides of the teeth.

• Complete the procedure by gently brushing the gums and tongue.

• Do not put toothbrush too far in the back of the mouth, which can cause gagging.

• Provide water for the patient to rinse his mouth if he is able.  Hold the bowl under his chin so that he can spit out the water.

• Clean and rinse the dentures and replace in the patient's mouth, if any.

• Wipe and dry the patient's lips and chin. Make the patient comfortable.

Performing Mouth Care Using Gauze/Cotton Swabs
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This method is useful for unconscious patient or those who cannot be propped up in bed.

• Wrap a towel under the patient's chin and round his shoulders to protect his clothing.

• If the patient wears dentures, remove them and put them in the container. Please refer to Care of Denture and Mouth.

• Prepare a cup of gargle solution dilute according to the instruction given.

• Hold the cotton ball/gauze with a forceps and dip it into the prepared solution.  Squeeze out excess solution to prevent it from dripping into patent's throat which may cause choking (aspiration).

• The comatose patient requires suctioning to prevent aspiration during oral care.

• Gently clean all the surface of the mouth including the teeth.

• Use fresh cotton balls/gauze in each dip to keep the solution fresh.

• Do not put cotton balls/gauze too far in the back of the mouth, which can cause gagging.

• Brush the tongue because it harbors bacteria that can cause dental problems.

• Clean the gum whether or not the patient is wearing dentures.

• Clean and rinse the dentures and replace in the patient's mouth.

• Finally, wipe and dry the patient's lips and chin; make the patient comfortable.

Note:  Alternatively, medicated cotton swab sticks can be used directly and conveniently to clean the mouth without any further addictives. These items are commercially available at pharmacies.
 

Care of Dentures and Mouth

• Brush or soak dentures with a denture cleaner in the morning, after meals and at bedtime.

• When using cleaning product, follow the instructions that come with the cleaner.

• The first step in cleaning dentures is to rinse away loose food particles thoroughly.

• Brush the dentures with soft bristles toothbrush under running water, holding it with the palm of your hand.  Brush every surface, scrubbing gently to avoid damage.  You may brush the denture with denture cleanser.

• Dentures are very delicate and may break if dropped.  Put a washcloth in the sink when washing them to prevent breakage from dropping.

• Always soak the dentures in a denture cup when not in use. Dentures may lose their shape if they are allowed to dry out.

• Never soak dentures in hot water because this can cause them to warp.

• Clean the patient's mouth after removing the dentures or ask him to rinse his mouth with water mixed with mouthwash.

• Use a soft toothbrush to massage the gums and roof of the mouth and tongue.

• Soak dentures overnight in a denture cup filled with a denture cleaning solution using tablets or paste.  The solution will help to loosen and remove stains and deposits.

• Rinse the dentures in running warm water again after soaking, and brush natural teeth, before putting dentures back into the patient's mouth.

• Loose dentures can cause irritation in the mouth.  Check the inside of the mouth for sores that may be caused by poorly fitting dentures.

• If dentures are causing sores, remove the dentures until the sores healed.
  

How to Remove Patient's Dentures
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Help the patient to remove his denture if he cannot do it by himself. 

• Put on gloves or use a tissue paper to hold the dentures.

• To remove a full denture, hold the denture with your thumbs and index fingers and tilt it away from the gum.  Gently wiggle the denture and pull it forward and out of the mouth.

• Put the denture in the denture cup.

• To remove a partial denture, lift the metal clamp with your fingertip.

• Cleaning the person's mouth after the dentures are removed.

Putting Dentures Back in Patient's Mouth
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Encourage the patient to wear his dentures if he has them, unless there is some reason for not doing so.  They will improve his ability to chew food, and will also improve speech and facial appearance. Help the patient to wear his denture if he cannot do it by himself.

• Put on gloves or use a tissue paper to hold the dentures.

• Apply adhesive liner or fixative to the dentures if the person uses them.

• Wet the dentures before putting them in the mouth to help seal them to the gums.

• Begin by gently inserting upper denture.  Use your thumbs and index fingers to press the denture firmly in place, sealing it against the palate.

• Repeat for the lower denture.

• Check the inside of the mouth for sores.  If present, refrain from wearing dentures until the sores healed.  Consult your doctor.

• Check with patient if the dentures feel comfortable when you have place them in his mouth.