7.2 Oral Care, Grooming & Dressing

Oral Care

Oral care (oral hygiene) keeps the mouth clean and moist and prevents pain, gum disease, bad breath, poor appetite, and aspiration pneumonia. Bacteria from a dirty mouth can travel to the lungs, so oral care is true infection prevention, not just comfort. Provide it at least in the morning and at bedtime (and after meals when possible), and more often for residents who are NPO (nothing by mouth), receiving oxygen, mouth-breathing, unconscious, or unable to clean their own mouth.

Provide privacy, apply gloves, and sit the alert resident upright. Brush teeth, gums, and tongue gently; floss only if it is part of the resident's routine and policy allows.

What the CNA Reports

• Bleeding, swollen, or receding gums
• White patches, sores, or ulcers in the mouth
• Loose, broken, or missing teeth
• Cracked lips or a very dry mouth
• Pain with chewing or refusal to eat
• Cracked or ill-fitting dentures

Unconscious Mouth Care

An unconscious resident still needs oral care and is at high aspiration risk. Use safe technique:

• Turn the resident to a side-lying position so fluid drains out of the mouth, not down the airway.
• Use only a small amount of fluid with oral swabs, not a dripping toothbrush.
• Never place your fingers between the teeth (a bite reflex can clamp down).
• Do not assume the resident cannot hear; explain each step.
• Keep suction nearby if it is part of the care plan, and report choking, coughing, or color change.

Denture Care and Grooming

Dentures are expensive, break easily, and are personal property. Handle them carefully.

• Line the sink with a towel and add a few inches of water before brushing, so dentures will not break if dropped.
• Brush all surfaces with a denture brush and cool water; hot water warps dentures.
• Rinse thoroughly before returning them to the mouth, and wet them so they slide in comfortably.
• Store dentures in a clean, labeled container of cool water or denture solution to keep them from drying and warping.
• Never wrap dentures in a tissue or napkin; they are thrown away by mistake this way.
• Report cracked, chipped, or ill-fitting dentures to the nurse.

Grooming

Grooming (hair, shaving, nails, makeup) supports self-image, identity, and dignity, so honor the resident's preferences and cultural practices.

• Comb or brush hair daily and style it the way the resident prefers.
• Use an electric razor for residents on anticoagulants (blood thinners) or with a bleeding risk, to avoid nicks and bleeding.
• For nail and foot care, do not cut the nails of a resident with diabetes or poor circulation; a small cut can become a serious wound. Report long or thick nails to the nurse, who follows facility policy.
• Clean under nails, soak feet per plan, and dry thoroughly between the toes.
• Brush or comb hair before the resident has visitors or meals to support self-esteem.
• Let the resident do as much as they safely can; hand them the comb or razor when they are able.

Dressing and Undressing

Dressing supports dignity and independence. Lay out clothing the resident chooses, provide privacy, and let the resident help where possible.

The Affected-Side Rule

When a resident has a weak, paralyzed, injured, or post-stroke side (the affected or weak side), the order of dressing matters:

Dressing the weak arm or leg first avoids forcing a stiff or painful joint through a tight sleeve and reduces strain. Undressing the strong side first lets the resident bend the good limb out while the weak limb is freed last with more room. With an intravenous (IV) line, dress the IV arm as if it were the affected side: guide the garment over the bag and tubing without lowering the bag below the site or disconnecting it; thread the bag through the sleeve last when removing.

Dignity in Dressing

• Keep the resident covered with a bath blanket while changing clothes.
• Offer choices and respect cultural or personal clothing preferences.
• Choose loose, easy-fasten clothing for residents with weakness or limited motion.
• Encourage the resident to fasten buttons, manage zippers, or pull up garments as able.

Common Exam Traps

• Choosing the resident's clothing for them, instead of offering choices, is wrong; it strips dignity and autonomy.
• Dressing the strong side first is the classic trap answer; the weak (affected) side always goes in first.
• Using hot water on dentures or a wet toothbrush flooding an unconscious resident's mouth are both wrong; cool water and a barely moist swab are correct.
• Cutting the toenails of a diabetic resident is outside CNA scope; report to the nurse instead.

Exam Tip

For Florida items: with a weak side, dress the affected side first and undress it last; with an IV, treat that arm like the affected side. Use an electric razor for blood thinners, line the sink for denture care, and position an unconscious resident side-lying for mouth care.