• Cavities in teeth
• Mouth infections
• Food particles stuck in the mouth
• Poor circulation to the gums
• Bad breath
• Bad taste in the mouth
• Reduced appetite
• Lower self-esteem

Tips for oral hygiene care

1. Ensure that the care receiver brushes at least twice a day and flosses at least once.
2. Don’t make them brush too often as this can wear away the tooth enamel and irritate the gums.
3. Use a toothbrush with soft bristles as they are not only more comfortable but are also more effective at removing food and plaque than hard-bristle toothbrushes.
4. Use a toothbrush of the appropriate size that fits the care receiver’s mouth.
5. Replace the toothbrush with a new one every three or four months, or if bristles become frayed and worn out.
6. Use toothpaste that contains fluoride as this removes plaque from teeth and gums and strengthens tooth enamel.
7. Encourage the care receiver to rinse their mouth as this gets rid of bacteria and prevents bad breath.
8. Encourage them to moisturise and lubricate lips and the mucosa (inner layer of the mouth) to prevent dry lips.

Procedure for brushing

1. Place the care receiver in an appropriate position
   1. If care receiver is conscious, place them in the Fowler’s position
   2. If care receiver is unconscious, raise the bed to a comfortable working height and turn the care receiver on their side facing you.
2. Wet the toothbrush and apply toothpaste.
3. For an unconscious care receiver, use foam swab or sterile cotton gauze dampened in clean water or a non-alcoholic mouthwash (e.g. Oral 7®) or sodium bicarbonate oral swabs if available. Dry the oral cavity after cleaning.
4. Place the toothbrush at a 45-degree angle to the gums.
5. Gently move the toothbrush back and forth in short (tooth-wide) strokes.
6. To clean the inside surfaces of the front teeth, tilt the brush vertically and make several up-and-down strokes.
7. Brush or scrape the tongue to remove bacteria and keep breath fresh.
8. Wash, rinse and dry the mouth.
9. Wash, dry and return all equipment.

Procedure for denture care

Care receivers with false teeth (dentures) need these dentures to be cleaned twice a day, once in the morning before breakfast and once at bed time.

1. Place the care receiver in Fowler’s position.
2. Wear gloves.
3. Place paper towel and kidney dish under care receiver’s chin to prevent soiling of clothing.
4. Ask the care receiver to remove their dentures. If they are not able to, assist them. Remove the upper denture first followed by the lower one.
5. Place the dentures in a clean denture cup.
6. Prepare mouth wash (e.g. thymol gargle) in a cup in the ratio of 1:3 (1 part of mouth wash and 3 parts of water)
7. Ask the care receiver to rinse their mouth with the mouth wash and spit it into the kidney dish.
8. Wipe the mouth with a towel.
9. Place the care receiver in a comfortable position.
10. Inform the care receiver that you are going to wash his denture.
11. Fill a clean sink with 3-4 inches (8 to 10 cm) of cool water and place a clean washcloth on the bottom of the sink. This will prevent the dentures from breaking if they are dropped.
12. Wet the toothbrush and apply toothpaste.
13. Thoroughly brush the dentures on all sides.
14. Rinse the dentures in cool running water and place them in a clean denture cup. Don’t rinse or soak them in hot water as this can cause them to bend.
15. Return the dentures to the mouth of the care receiver with the upper denture returned first. If the care receiver doesn’t intend to wear them immediately, store them in a clean denture cup filled with cool water or with denture solution and mark them with the care receiver’s name and IC.
16. Remove, clean and return the equipment.
17. Remove gloves and wash hands.

Article reviewed by David Tay, Senior Principal Educator (Nursing and Prehospital Care), HMI Institute.