Oral Hygiene, Denture & Mouth Care

Oral Hygiene, Denture & Mouth Care

Oral care is the ADL most often rushed and the one with the largest downstream consequences. Poor mouth care in long-term care drives aspiration pneumonia, painful chewing and therefore weight loss, gum disease, and a loss of dignity that residents feel acutely. Two of the twenty-two Rhode Island skills — Provides Mouth Care and Cleans Upper or Lower Denture — are drawn from this single ADL sub-topic, so it is disproportionately worth your study time.

Frequency

Oral Care for the Conscious Resident

1. Wash hands, gather equipment, provide privacy, explain the procedure speaking clearly and directly, face to face.
2. Position the resident upright in High Fowler's, 75 to 90 degrees. On the NNAAP skill this is a scored step; upright positioning is what prevents aspiration of toothpaste, water, and secretions.
3. Put on clean gloves before cleaning the mouth. Mouth care always involves contact with saliva and often blood — gloves are required by Standard Precautions.
4. Place a cloth towel across the chest.
5. Moisten the toothbrush, then apply toothpaste to the moistened brush.
6. Clean the mouth including the tongue and all surfaces of the teeth, using gentle motions. Brush at a 45-degree angle to the gum line; brush the tongue from back to front to remove the bacterial film that causes bad breath.
7. Hold the emesis basin to the chin while the resident rinses.
8. Wipe the mouth, remove the clothing protector, and dispose of used linen in the soiled linen container.
9. Rinse the toothbrush and place it in the designated container; empty, rinse, and dry the basin.
10. Remove and dispose of gloves without contaminating yourself, then wash hands.
11. Verify the signaling device is within reach and the bed is in the low position.

💡 Flossing is done gently between all teeth if it is part of the resident's routine, moving from the top to the bottom and using a fresh section of floss for each space. Stop and report if the gums bleed heavily.

Oral Care for the Unconscious Resident

This is the highest-risk version of the skill, and the exam tests the safety logic rather than the sequence.

• Turn the resident onto the side with the head turned toward the side. Gravity, not suction, is your protection: secretions and rinse fluid must run out of the mouth into an emesis basin or towel.
• Never place a glass of water, a straw, or your fingers in the mouth. Use padded tongue blades or oral swabs to hold the mouth open. An unconscious resident can still bite reflexively.
• Use only a small amount of fluid on swabs, squeezing out the excess. Rinse with a moistened swab, not a poured rinse.
• Explain what you are doing anyway. Hearing is generally the last sense lost. Speak to the resident throughout.
• Clean the gums, tongue, inner cheeks, roof of the mouth, and teeth.
• Apply a water-soluble lubricant or lip balm to prevent cracked, bleeding lips. Avoid petroleum-based products if the resident is on oxygen and facility policy prohibits them.

Denture Care

Dentures are expensive, fragile, and personal. Losing or breaking a resident's dentures is one of the most common preventable complaints in long-term care.

The NNAAP denture skill, step by step

1. Put on clean gloves before handling the denture.
2. Line the bottom of the sink with a towel and/or partially fill the sink with water before the denture is held over it. This is the anti-breakage step and is scored — a denture dropped onto porcelain shatters.
3. Rinse the denture in moderate-temperature running water before brushing. Hot water warps the acrylic base and ruins the fit permanently.
4. Apply denture toothpaste to the toothbrush — regular abrasive toothpaste scratches denture acrylic, and scratches harbor bacteria.
5. Brush all surfaces of the denture.
6. Rinse all surfaces under moderate-temperature running water.
7. Rinse the denture cup and lid.
8. Place the denture in the cup with moderate-temperature water or denture solution and put the lid on.
9. Rinse the toothbrush and place it in the designated container.
10. Maintain clean technique with placement of the toothbrush and denture throughout.
11. Remove the sink liner and/or drain the sink appropriately.
12. Remove and dispose of gloves without contaminating yourself, then wash hands.

Denture handling rules

• Store dentures in water or solution, never dry. Drying cracks and distorts them.
• Label the denture cup with the resident's name and keep it in the same place every time.
• Remove the upper denture first (break the suction seal by moving it gently up and down) and insert the upper denture first as well.
• Never wrap dentures in a tissue or napkin — that is how they end up in the trash.
• Provide mouth care to the gums, tongue, and palate even when dentures are out.

What to Report

Report any of the following to the licensed nurse; none of them are things a nurse aide treats: