Good mouth-care before and after eating

As the dying person’s oral intake decreases care should include regular mouth care performed with sensitivity and compassion. The care giver should continue to explain to the dying person and relatives the plan to carry out mouth care.

Providing good mouth-care is essential to ensure people feel as comfortable as possible.

Your patient may develop problems with their mouth such as dryness, ulcers or an infection. These problems can sometimes be made worse by the medication they are taking.

If the dying person closes their mouth shut during attempts to give mouth care then this should be taken as the dying person’s indication that mouth care is not wanted at that time and mouth care should cease and be offered again at another time. Some family members may like to be involved in mouth care and should be supported by caregivers to do this.

Steps for good mouth care:

  • If possible sit the patient in a suitable chair with their feet firmly on the ground
  • If the patient is bed bound raise the bed to an incline and use pillows to support the back, head, neck and shoulders. Tilt the head forward and to one side to assist drainage
  • For patients in bed with unilateral facial paralysis, the head should be tilted away from the affected side
  • A smear of non foaming toothpaste on a dry toothbrush is advisable.
  • Chlorhexidine Gluconate gel (does not foam) may be used as an alternative to toothpaste. It will also help to control plaque bacteria
  • Encourage the patient to spit into a bowl or basin to remove any excess toothpaste
  • An aspirating toothbrush can be used for individuals who are totally Nil by Mouth. These are specialised products and must be fitted to a suction unit at the bedside or to a portable unit
  • Suction will be required to aspirate oral fluids and debris. (Aspirating tooth brush connected to a manual pump)

For medically compromised individuals or those with complex needs you may need to modify your approach.