9.2 Oral Hygiene, Denture Care, and Mouth Care for Unconscious Residents

Oral hygiene is essential for resident comfort, dignity, and health. Poor oral hygiene can lead to aspiration pneumonia, infections, and decreased food intake. Mouth care for a conscious resident, mouth care for an unconscious resident, and denture care are all among the 21 mandated INACE performance skills.

Why Oral Hygiene Matters

• Prevents aspiration pneumonia — bacteria from the mouth can be inhaled into the lungs
• Improves appetite — a clean mouth enhances taste and comfort
• Prevents infections — oral bacteria can cause systemic infections
• Promotes dignity — fresh breath and clean teeth support self-esteem
• Prevents tooth decay — brushing removes plaque and food particles
• Assesses oral health — opportunity to observe for sores, bleeding, or changes

Mouth Care for Conscious Residents (INACE Skill)

1. Wash hands, identify resident, explain procedure
2. Position resident in Fowler's or semi-Fowler's position (head elevated 30-45°)
3. Provide privacy
4. Apply toothpaste to a moistened soft-bristled toothbrush
5. Brush all surfaces of teeth: outer, inner, and chewing surfaces
6. Brush the tongue gently
7. Have the resident rinse with water and spit into an emesis basin
8. Apply lip moisturizer if requested
9. Document care and any observations

Mouth Care for Unconscious Residents (INACE Skill)

This is a critical skill because unconscious residents are at high risk for aspiration:

1. Wash hands and apply gloves
2. Position the resident on their side (lateral position) with the head turned toward you
3. Place a towel under the head and an emesis basin under the chin
4. Use a moistened sponge-tipped swab or soft toothbrush (no toothpaste or use very small amount)
5. Gently clean all tooth surfaces, gums, tongue, and inside of cheeks
6. Use suction if available to remove excess fluid (or wipe with gauze)
7. Do NOT pour water into the mouth — aspiration risk
8. Apply lip moisturizer
9. Reposition the resident comfortably
10. Document care and observations

Critical Safety Points for Unconscious Mouth Care:

• NEVER place your fingers between an unconscious resident's teeth — they may bite reflexively
• NEVER pour liquid into the mouth — cannot swallow, will aspirate
• ALWAYS position on the side — gravity helps drain fluids away from the airway
• Use padded tongue depressor or bite block to hold the mouth open if needed

Denture Care (INACE Skill)

1. Wash hands and apply gloves
2. Ask the resident to remove dentures, or gently remove them using a gauze pad for grip
3. Handle dentures carefully — they are expensive and fragile
4. Line the sink with a towel or fill the basin with water (cushion in case dentures are dropped)
5. Hold dentures over the basin, not over the sink
6. Brush dentures with a denture brush and denture cleaner (not regular toothpaste — it is too abrasive)
7. Rinse thoroughly under cool or warm running water (NOT hot — hot water can warp dentures)
8. Provide mouth care for the gums, tongue, and palate while dentures are out
9. Place dentures in a labeled denture cup with cool water or denture solution when not being worn
10. Help the resident reinsert dentures if requested
11. Document care

Observations During Oral Care

Report to the nurse:

• Bleeding gums
• Sores, lesions, or white patches in the mouth
• Loose, chipped, or broken teeth
• Ill-fitting dentures causing pain or irritation
• Swelling of gums, tongue, or cheeks
• Unpleasant odor despite regular care
• Difficulty swallowing or resident complaints of mouth pain