4.2 Oral Care and Denture Care

Oral Care and Denture Care

Quick Answer: For natural teeth, brush at a 45-degree angle to the gumline using small circular motions, with the resident in an upright (Fowler's) position to prevent aspiration. For dentures, brush with a denture brush over a lined basin (never a sink — dentures break if dropped), rinse with cool water, and store in a labeled, water-filled cup. Never wrap dentures in a tissue — they will be thrown away.

Oral care is performed at least twice a day (AM and PM) and after meals when ordered. The mouth is a primary reservoir of infection — bacteria from poor oral hygiene travel to the lungs and cause aspiration pneumonia, a leading cause of death in nursing home residents. Indiana's infection control rules and the OBRA quality-of-life requirement both make mouth care a high-priority CNA task.

Natural Teeth — Brushing Technique

1. Position the resident upright in Fowler's position (45–60 degrees). If the resident cannot sit up, turn the head to the side and use a towel to catch drainage. Never perform oral care on a supine resident — aspiration risk is highest flat on the back.
2. Wash hands and put on gloves. Oral mucosa carries both normal flora and pathogenic organisms; standard precautions apply.
3. Use a soft-bristled toothbrush and a pea-sized amount of fluoride toothpaste. Hard bristles damage gums; too much toothpaste causes frothing and gagging.
4. Hold the brush at a 45-degree angle to the gumline. Brush in small circular motions, two to three teeth at a time. Brush all outer surfaces, inner surfaces, and the chewing surfaces.
5. Brush the tongue gently to remove bacteria and prevent halitosis.
6. Rinse with small amounts of water. Have the resident lean forward over a basin or emesis basin. Use only small sips — large volumes increase aspiration risk.
7. Floss if ordered. If the resident cannot floss independently, use a floss holder and floss gently between each tooth. The CNA role may be limited by the care plan — follow orders.
8. Wipe the mouth, remove gloves, and wash hands. Document the care and report any bleeding, sores, white patches (possible thrush), or broken teeth to the licensed nurse.

Aspiration Precautions

Aspiration — fluid or food entering the lungs — is a sentinel event. Reduce risk by following these precautions at every oral care session:

Trap to remember: If a resident is unconscious or has an impaired swallow, oral care is done with a suction toothbrush or sponge-tipped swab (Toothette) moistened — not soaked — with water or mouthwash. Turn the head to the side. Never use a toothbrush with toothpaste on an unconscious resident. Report any coughing, gurgling, or difficulty swallowing immediately.

Denture Care — Technique

Dentures are removable artificial teeth. They are expensive, easily damaged, and losing them is a dignity and quality-of-life crisis for the resident. Handle dentures with the same standard precautions as natural-teeth care.

1. Wash hands and put on gloves.
2. Remove the dentures. Gently rock the upper denture down and out; slide the lower denture up and out. Place them in a labeled basin.
3. Brush the dentures over a lined basin or towel — never over an empty sink. If dropped, dentures crack. Use a soft denture brush and denture cleaner (some residents use mild soap — never hot water, which warps the plastic).
4. Rinse thoroughly under cool running water.
5. Brush the resident's gums, tongue, and palate with a soft toothbrush or sponge swab to stimulate circulation and remove debris.
6. Reinsert the dentures if the resident wants them, or store them (see below).

Denture Storage

Trap to remember: The single most-tested denture storage rule is the labeled, water-filled cup. "Tissue wrapping" is the wrong answer on every exam — housekeeping discards tissue-wrapped items. "On the bedside table" is also wrong — dentures must be in the labeled cup or in the resident's mouth.

Infection Control in Oral Care

Oral care involves contact with saliva, blood (if gums bleed), and mucous membranes. Standard precautions apply:

• Gloves on before any mouth contact
• Gloves off and hand hygiene after care
• Never use a toothbrush or denture brush on more than one resident
• Never share a tube of toothpaste between residents — use individual tubes or single-use packets
• Report oral lesions, bleeding gums, thrush (white patches on tongue or palate), or broken/loose teeth to the licensed nurse

Documentation and Reporting

After oral care, document the care given, the resident's response, and any abnormalities. Report immediately:

• Bleeding that does not stop
• White patches (possible oral thrush — a fungal infection requiring antifungal medication)
• Broken or loose teeth
• Mouth sores or ulcers
• Difficulty swallowing or coughing during care (possible aspiration)