Oral care at end of life

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Importance of oral care: 

• Helps prevent and treat common issues such as mouth pain and discomfort, dry mouth and oral infections. 

Impacts of poor oral care:

• This can affect people in different ways.
• Impact on the ability to swallow food or liquids.
• Cause food or drinks to taste different.
• Be uncomfortable or painful.
• Cause fungus and bacteria in the mouth, which leads to bad breath.

Preparing for oral care: 

• You will need a circular or small-headed toothbrush with soft bristles.
• You can also use a silicone mouth cleanser.  

Avoid regular toothpaste. It can be too strong or uncomfortable:

• At end of life, foam flavours can cause discomfort and can be difficult to remove from mouth. 
• Instead, use alternatives such as water, saliva replacement gel, cider or natural sparkling apple juice. It will depend on personal preference.

Before you begin:

• Explain to the person that you will open their mouth and clean it. Even if they are no longer responsive, it is likely they can hear you.  
• If the person is in a hospital bed, lift the backrest to around 75° or use pillows to lift the person’s back. 
• Make sure your hands are clean. 

Checking the mouth: 

• Gently open the mouth.
• Check for sores, signs of infection and cracks on the tongue.
• These can be very uncomfortable, so perform these checks carefully.
• You can also use a torch if you are having trouble seeing inside the mouth.

Cleaning process

• Always clean the mouth before applying any medications.
• To start, apply preferred cleaning liquid to chosen mouth cleanser. 
• Hold a clean cloth or napkin under the mouth with one hand.
• Use dominant hand to hold the mouth cleanser. Perform a rolling motion with it to spread the product evenly.
• Start slowly and remove any crusty, dried saliva and hard secretions from the mouth. These can be found at the roof of the mouth, the tongue or around the gums.
• If these are hard to remove, you can apply dry mouth gel and wait for a few minutes.

Lip care:

• Near end of life, the lips can become severely dry. 
• In this case, clean the lips using the same liquid you use in the mouth.
• Once lips are clean, apply saliva replacement gel. Olive oil can also be used as it is effective in hydrating the lips.

Important tips and safety: 

• Be careful when using foam swabs. The foam head can become detached or the person can bite it. It can also be a chocking hazard. 
• Glycerin swabs and mouth washes are not recommended as they can further dry the mouth.
• Instead, a mouth hydrator can be used to moisten the lips, tongue and soft tissues inside the mouth.
• With a slow flow of water from two drip holes, a gentle compression on the lips or inside the mouth is enough to provide a slow flow of water in the mouth safely. This will reduce risk of chocking.

Additional comfort measures:

• If the person can chew, offer cold pineapple chunks or ice lollies. This can help to produce saliva which can provide relief from symptoms. 

Denture care:

• Remove dentures before caring for the mouth.  
• Always clean the dentures as part of the mouth care routine. Make sure you clean the denture according to the manufacturer’s instructions.
• Remember to also clean the dentures well, otherwise they can accumulate food and secretions, causing oral infections.

Safety warning:

• Never put your fingers inside the mouth. The biting and chewing reflex remains strong, even if the person has very little awareness.