What Is Oral Care?

Oral care is the mechanical removal of oral bacteria by brushing the entire oral cavity. Your loved one may require intensive oral care at least twice a day to ensure his/her mouth is free from bacteria overgrowth. Intensive oral care may reduce the incidence of aspiration pneumonia by:

  • Reducing colonisation of bacteria in the oral cavity and saliva
  • Improving cough reflex sensitivity
  • Enhancing saliva production​

Why Is Oral Care Important?

Oral care is important in maintaining good oral hygiene. Good oral hygiene can have a significant impact on a person’s general well-being and quality of life.

Conversely, poor oral hygiene can lead to mouth pain, gum disease and tooth loss. If left untreated, severe gum disease may infect the surrounding bone and tissue, leading to other systemic diseases. Poor oral hygiene also increases the risk of pneumonia, especially in patients with dysphagia (swallowing difficulty).

Research shows that good oral care methods can reduce hospital admissions.

In addition, prolonged poor oral care may also lead to malnutrition, as patients tend to eat less when there is an ulcer or pain in the mouth.

Contrary to conventional belief, patients with no remaining dentition also need oral care, especially for gum surfaces, palate and tongue areas where bacteria can colonise. It is also important to note that patients on tube feeding also require oral care. As these patients are more prone to pneumonia due to swallowing difficulty, oral care needs to be done thoroughly for them.

Preparing for Oral Care

Oral Cleaning Tools

  1. Toothbrushes
    • The best option for oral cleaning
    • Cleans better than swabs
    • Economical
    • Use small-ended toothbrushes with soft bristles
  1. Foam swabs or sterilized cotton gauze/soft cloth
    • For patients with bleeding, difficulty in swallowing and/or tendency to bite on a toothbrush
    • For most patients, use with normal saline mouthwash or non-alcoholic mouthwash, e.g., Colgate Plax
    • For patients who just underwent tooth extraction or have mouth ulcers
    • Chlorhexidine, 0.2% mouthwash, may be used for up to 4 weeks
    • Single-use only

Oral Cleaning Agents

  1. Fluoride toothpaste
  2. Normal saline mouthwash OR Non-alcoholic mouthwash
    e.g., Colgate Plax (Avoid glycerin or alcohol-based agents)
  3. Chlorhexidine 0.2% mouthwash ONLY when needed

Additional Materials

  1. Lip moisturizer
  2. Denture cleaning agent (Not compulsory. NOT SUITABLE for METAL DENTURES)

Cleaning the Oral Cavity

Physically Independent Patients

For patients who are physically independent, have no significant swallowing difficulty and are able to gargle.

  • Perform oral care at least twice a day.
  • Use a toothbrush with flouride toothpaste to brush all teeth, gums, tongue, palate areas for at least 2 minutes.
  • Gargle with sodium chloride solution or water twice a day or after every meal.
  • Use a soft-bristle, soft-ended toothbrush.

Patients Requiring Assistance in Oral Care

  1. Assisted patients: Conscious patients requiring some assistance in oral hygiene, having some swallowing difficulty and/or are unable to gargle.
  2. Dependent patients: Unconscious patients requiring complete assistance, having significant swallowing difficulty and/or that are unable to gargle.
    1. Perform oral care at least twice a day (after waking up and before going to sleep). Increase frequency if the patient has significant drooling and secretions. For a person who has food residue kept in the mouth, oral care should also be performed after meals.
    2. Wash and dry hands thoroughly, and put on gloves before performing oral hygiene.
    3. If the patient still has some remaining teeth, brush all tooth surfaces with a toothbrush, followed by a foam swab or sterile gauze dipped in sodium chloride solution.
    4. For patients with no remaining dentition, use a foam swab or sterile cotton gauze dipped in sodium chloride solution OR a non-alcoholic mouthwash to clean all surfaces of the oral cavity (including palate, gums, inner cheek areas) for at least 2 minutes.
    5. For patients with very poor oral hygiene, use chlorhexidine 0.2% mouthwash (not more than 4 weeks) instead of sodium chloride solution.
    6. Apply lip moisturiser or moisten lips with damp cotton gauze if needed. For patients with thick, crusted secretions, moisten the mouth regularly. DO NOT peel off dry secretion.
    7. Dependent patients may also require suctioning.

Cleaning Dentures

  • Clean with a denture brush or soft toothbrush and water at least twice a day.
  • Soak dentures in clean water when not in use.
  • Once a week, soak in denture-cleansing agents to remove stains. Rinse off the cleaning agent before wearing dentures.
  • Keep dentures in a clean denture storage container, completely soaked in water

Other Useful Tips for Oral Care

  • Use normal saline if the patient is hypersensitive to Chlorhexidine or is on Nystatin treatment.
  • Avoid food and drinks for 30 minutes after using chlorhexidine mouthwash.
  • Discard unused Chlorhexidine 0.2% solution 48 hours after opening.
  • Inform a doctor or dentist when ulcers or bleeding is seen in the oral cavity and administer medication as prescribed.
  • Visit your dentist regularly. After your regular dental check-up, your dentist will advise on the recommended frequency of your dental visits to maintain good oral health. 

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