3.2 Oral Hygiene, Dentures, and Unconscious Mouth Care
Key Takeaways
- Oral care should be provided at least twice daily and PRN (as needed) — after meals and at bedtime are standard times.
- Brush teeth gently with a soft-bristled toothbrush; floss as ordered by the care plan.
- Dentures are cleaned over a basin of cool water or a folded towel, stored in a labeled container with cool water or denture solution, and never placed in hot water (warps the plastic).
- Mouth care for unconscious residents is performed in a side-lying position with suction available; never put fluids in the mouth of an unconscious resident — aspiration risk.
- Use a soft swab and mouth moisturizer rather than drying agents; modern best practice avoids lemon-glycerin swabs because they dry oral tissues.
Why Oral Care Matters
Poor oral hygiene in long-term care residents is directly linked to aspiration pneumonia, the leading infectious cause of death in nursing homes. Bacteria-laden saliva micro-aspirated into the lungs causes infection — so brushing teeth is literally pneumonia prevention. North Carolina facilities are surveyed on documented twice-daily oral care, and the NNAAP skills test commonly includes a denture or unconscious mouth care station.
Frequency
- At least twice daily — typically after breakfast and at bedtime.
- PRN (as needed) — after meals, after vomiting, before visitors, when the resident requests it.
- Every 2 hours for residents who are NPO (nothing by mouth) or unconscious, because the mouth dries out without normal eating and drinking.
Brushing Natural Teeth
- Wash hands and apply gloves.
- Raise the head of the bed to a sitting position (Fowler's, 60–90°) — never brush teeth with the resident flat on the back.
- Use a soft-bristled toothbrush and a pea-sized amount of toothpaste.
- Brush in gentle, short strokes at a 45° angle to the gum line.
- Brush all surfaces — outer, inner, and chewing surfaces — plus the tongue.
- Offer water in a cup or rinse with a swab; have the resident spit into an emesis basin.
- Floss only if ordered, and use a fresh section of floss for each tooth.
- Observe for bleeding gums, loose teeth, sores, white patches, or bad breath — report all findings.
Denture Care
Dentures are personal, expensive (often $500–$3,000 per set), and easily lost or broken. Treat them with care.
Removing Dentures
- Apply gloves.
- Use a gauze square to grasp the upper denture — it is slippery.
- Gently rock the upper denture up and down to break the suction seal, then remove.
- Remove the lower denture by lifting and turning slightly.
Cleaning Dentures
- Line the sink basin with a folded washcloth or paper towel, or fill the basin partly with cool water. This prevents breakage if the dentures slip.
- Brush all surfaces with a denture brush and denture cleanser (or mild toothpaste).
- Rinse with cool or lukewarm water — never hot. Hot water warps the acrylic plastic permanently.
Storing Dentures
- Store in a labeled, covered denture cup filled with cool water or commercial denture solution.
- Keep them moist at all times — drying cracks the plastic.
- Place the cup in the resident's bedside drawer, never on a meal tray (they get thrown out with the food).
Mouth Care for the Unconscious Resident
Unconscious or heavily sedated residents cannot swallow, gag, or protect their airway. Standard oral care must be modified to prevent aspiration.
Position
- Place the resident in a side-lying (lateral) position with the head turned to the side.
- Place a towel and emesis basin under the chin to catch fluids.
- Have oral suction equipment ready and turned on before you start.
Technique
- Apply gloves.
- Open the mouth gently — never force. If needed, use a padded tongue depressor, not your fingers (residents can bite reflexively even when unconscious).
- Use a moistened soft swab (sponge-tip applicator) to clean teeth, gums, tongue, and the inside of the cheeks.
- Use plain water or an alcohol-free mouthwash on the swab — moisten, don't soak.
- Apply a water-based lip moisturizer to lips and a thin film of mouth moisturizer to the oral mucosa to relieve dryness.
- Never give fluids by mouth to an unconscious resident — aspiration risk.
- Suction any pooled secretions.
A Note on Lemon-Glycerin Swabs
Lemon-glycerin swabs were a standard tool for decades. Current best practice avoids them because the lemon (citric acid) and glycerin actually dry oral tissues and decalcify tooth enamel over time. Use plain water, saline, or a commercial mouth moisturizer instead. If a North Carolina exam item mentions lemon-glycerin, the correct answer almost always favors plain water or an oral moisturizer.
Reporting and Documenting
Always report and document:
- Bleeding gums, broken or loose teeth
- Sores, ulcers, or white patches (possible thrush)
- Cracked or missing dentures
- Resident refusal of oral care (and your follow-up)
- Bad breath that is new or worse than usual (possible infection)
A CNA at a North Carolina nursing facility is providing mouth care for a resident who is unconscious. Which action is MOST important to prevent aspiration?
A CNA finishes cleaning a resident's dentures. The correct storage method is to: