Mouth care for people with swallowing problems

Taking care of the mouth is especially important for people who have trouble swallowing (dysphagia).

People who can’t eat or drink, or who only have limited oral consumption, are at higher risk of poor oral hygiene and need extra help with cleaning their mouths. If they rely on others for mouth care and have trouble swallowing, they are at a higher risk of developing pneumonia. For people with very severe swallowing problems or who can’t eat (nil by mouth), there is a risk of choking on toothpaste or food debris. It’s important to be careful during mouth care.

Basic mouth care guidelines

Because swallowing problems vary, there is no one-size-fits-all approach to mouth care for people with dysphagia. However, here are some general tips that can be adjusted based on your needs:

Mouth care for people who need help

• Stay as upright as possible during mouth care to prevent food or liquid from going into the lungs.
• Check your mouth: remove dentures, loose items, or any food stuck in the mouth using a damp, soft cloth.
• If lips are dry or cracked, apply a water-based balm.
• If appropriate, put a small amount of non-foaming toothpaste on a soft toothbrush or electric toothbrush.
• To keep the mouth hydrated, you can dampen the toothbrush or gauze with water or mouthwash.
• Focus on cleaning areas where food and plaque collect first (like gums and chewing surfaces). Try to clean all the surfaces of the teeth.
• If unable to spit, use a damp cloth to remove excess toothpaste and food.
• Brush teeth twice a day, especially after the last meal. If meal supervision is needed, simple mouth care after each meal is important to prevent food from going into the lungs and to avoid mouth infections.
• If appropriate, an electric toothbrush with a suction feature may help. This can make brushing easier and more effective.
• Brush the tongue if it’s coated with a soft toothbrush.
• If your mouth is especially dirty or the gums are bleeding, use a small amount of mouthwash or gel with a toothbrush.
• Use special interdental brushes to clean between the teeth if needed, and follow advice from a dentist or oral health expert.
• Check the mouth for sores or mucus. To remove dried mucus from the mouth, Apply water or water-based gel to a toothbrush, 360 toothbrush or MC3 stik to gently rub and remove the mucus with a damp cloth.

Mouth Care at the end of life

People nearing the end of life often rely on staff or caregivers for their mouth care. Sadly, this important part of care is sometimes forgotten or skipped. When the mouth isn’t looked after, it can lead to bad breath (halitosis), which can impact on contact with friends and family members as an unpleasant aroma from the mouth can be off putting causing loved ones to avoid having close contact or kiss the person.

Care Plan

Mouth care should be part of the person’s care plan and focus on comfort and improving their quality of life. This can include:

• Pain relief
• Treating dry mouth
• Removing sticky or dry secretions
• How often the mouth should be rinsed or checked

This plan helps make sure care stays consistent, even when the person moves between care settings or has different caregivers.

Assessment

The main goal of mouth care at the end of life is comfort, not cure.

• Use gloves, a torch, and a tongue depressor to check the mouth.
• Take out any dentures before examining.
• Look for signs of pain, dryness, coating on the tongue, sores, infection, or tooth decay.

Dry Mouth

People at the end of life often breathe through their mouth, which can cause dryness. A dry mouth is uncomfortable and can lead to thick, sticky secretions that are hard to remove.

• Use water or dry mouth gel on a soft toothbrush or a 360 toothbrush or MC3 stick to keep the mouth moist.
• If the person is awake, check and hydrate the mouth every 30 minutes.
• If the person is unconscious, do this at least every hour.
• Keep lips soft with water-based lip balm or gel.

Dried sticky secretions

As swallowing and coughing become weaker, saliva and mucus can build up in the mouth. These secretions can dry out and stick to the tongue and roof of the mouth, making them hard to remove.

Management

• Use a soft toothbrush or a special tool (like a 360 toothbrush) to gently clean these areas.
• Keeping the mouth clean and moist helps with comfort and dignity.

Involving loved ones

Letting loved ones help with mouth care can help them feel useful and connected, and it’s a way for them to show care and support.

End of life mouth care tips

• Check the mouth daily for changes.
• Remove dentures, clean with mild soap and water, and store them dry in a labelled container.
• Brush teeth gently with a soft brush and mild, non-foaming toothpaste.
• Clean the mouth as often as needed to keep it fresh and comfortable.
• Offer help to clean teeth or dentures if the person can still do some care themselves.
• If the person can’t tolerate a toothbrush, use damp gauze (moistened with water or mouthwash) wrapped around your finger to wipe the mouth.
• Use water-based lip balm to prevent cracked lips.
• Review medications that may be causing a dry mouth.
• For people who are conscious, hydrate the mouth every 30 minutes.
• For those who are unconscious, moisten the mouth at least every hour, or more often if needed.

Important warnings

‘Taste for Pleasure’ is a way of keeping the mouth hydrated at the end of life with a person’s favourite flavour. Whilst there is not a problem with hydrating someone’s mouth with flavoured beverages such as flavoured squash, tea and coffee.

• Don’t use alcohol to hydrate the mouth. Even if it’s the person’s favorite drink, alcohol dries out the mouth and can make things worse.
• Don’t use foam swabs. These can be dangerous if the sponge tip comes off and could be a choking hazard.
• Be careful with glycerine swabs. Although they may seem helpful, glycerine actually dries the mouth out even more.
• Swabs are not good at cleaning teeth. Use a toothbrush or appropriate tool to remove plaque effectively.