Supporting oral care: Advice for health and care professionals

Mouth care for people with swallowing difficulties

People with dysphagia are at higher risk of poor oral hygiene, infection, and pneumonia— rely on others for care. People who are nil by mouth may struggle with toothpaste, therefore mouth care must be delivered carefully and consistently. People with oral stage difficulties often struggle to clear their mouths and may choke on food debris.

Key principles of oral care

There is no single approach; care must be tailored to each person’s swallowing ability.

• Daily care includes:
  • Preparing properly (hand hygiene, PPE, good lighting, clear explanation).
  • Brushing twice daily with fluoride toothpaste.
  • Cleaning gums, tongue, and soft tissues.
  • Maintaining denture hygiene
  • offering moisturisers for dry mouth.
• Carers should observe for redness, swelling, ulcers, thrush, broken teeth, loose dentures, bad breath, or signs of pain, and record and escalate concerns.

Supporting people who resist care

Resistance often stems from pain, fear, sensory overload, or communication difficulties. Helpful strategies include:

• Approaching calmly and slowly.
• Using simple explanations.
• Offering choices.
• Trying again later if distressed.
• Involving familiar carers when appropriate.

What good practice looks like

1. Routine assessment:
   Regular oral health assessments, documentation, and timely escalation of concerns.
2. Daily mouthcare delivery: Consistent brushing, tissue cleaning, denture care, and management of dry mouth or oral infections.
3. Person‑centred approaches: Clear explanations, consent, pacing care to the individual, and addressing causes of resistance.
4. Workforce training and culture: Staff training, embedding mouthcare into daily routines, and ensuring adequate time and resources.
5. Access to dental services: Supporting routine dental visits, liaising with community dental teams, and having clear pathways for urgent issues.

Key messages

• Mouthcare is not optional. it is essential care.
• People who need help rarely ask for it.
• Good mouthcare prevents serious illness and improves quality of life.
• Skilled, compassionate support makes a significant difference.
• Awareness of this need and proactive care is vital.

More information

National guidance and resources

• NICE (2016): Oral health assessment, care planning, staff training and escalation.
• OHID and HEE (2020): Training resources and competency frameworks.
• Mouthcare Matters: Evidence‑based tools and training that improve outcomes.

Access the free e-learning course about mouthcare