Oral care where care is needed

When someone can no longer care for their own teeth, another person takes it on — and that person faces a task nobody has explained to them. Oral care is among the activities that most often get too little attention in home care. It is at the same time one of the most effective.

Why it is so important

In people with a weakened swallowing reflex, small amounts of saliva reach the airways. If there are many bacteria in it, pneumonia can develop from this — one of the most common causes of death in people needing care. Studies in care homes consistently show: where oral care is improved, the number of cases of pneumonia falls markedly.

Added to this is pain that nobody reports. Someone who can no longer express themselves shows an inflamed tooth or a pressure sore differently: by refusing food, by restlessness, by resisting having their face washed, by picking at their cheek. Anyone who knows these signs looks in the mouth — and often finds something.

How it works in practice

• A fixed time and a fixed order. Repetition creates security.
• Work from behind or from the side, not from the front. Support the person's head against your own shoulder or a cushion — that is more comfortable for both and gives a better view.
• Good light: a lamp or a head torch. What you cannot see, you do not brush.
• An electric toothbrush, if it is accepted. It takes the movement off the carer.
• Little toothpaste, and with swallowing difficulties very little, or a gel instead of a foaming paste — foam tempts swallowing.
• Announce every action, even when no answer comes.
• Do not force everything at once. Better a little every day than thoroughly once a week against resistance.

With dementia

Here brushing rarely fails because of refusal and mostly because the sequence of the action has been lost. The person no longer knows what to do with the brush. From this follow techniques that are well established:

• Demonstrate rather than instruct. Brush your own teeth at the same time — imitation often works when words no longer reach.
• Initiate the movement: guide the person's hand with the brush and then let go. Often the movement continues by itself.
• Short, clear sentences, always the same ones. One sentence per action.
• Keep familiar routines: the same bathroom, the same time, the same toothpaste.
• Stop when there is resistance and try again later. The resistance is an expression of being overwhelmed or in pain, not of defiance.
• Check for pain when the resistance appears for the first time.

Dentures

Removable dentures are cleaned daily with a denture brush and liquid soap or washing-up liquid, over a basin filled with water. Cleaning tablets complement the brushing but do not replace it. No toothpaste — its abrasiveness scratches the plastic.

At night the denture should as a rule come out, dry in a labelled container. The label is not a detail in a care home: mixed-up dentures are a common problem and hard to resolve.

A mouth without teeth needs care too. Alveolar ridges, palate and tongue are cleaned with a soft brush or a damp cloth. Otherwise a fungal infection easily develops on the mucosa beneath a denture — recognisable by reddened areas and whitish deposits.

What to look out for

• white, wipeable deposits on tongue or palate — suspicion of oral thrush
• reddened areas beneath the denture or cracked corners of the mouth
• sore places that persist for more than a week
• sudden refusal of food or chewing on one side only
• bad breath that appears for the first time
• a denture that no longer fits

Every one of these points should be looked at by a dentist. That someone needs care is no reason to wait — for exactly these situations there are services of their own and the option of the practice coming to the house.