Mouth care in palliative care Hauora ā-waha ki te manaakitanga whakamaene
Often people at the end of their life need someone to keep their mouth clean because they cannot do it themselves. It is important to do this because it reduces the risk of infections in their mouth.
Why mouth care is needed
If you are caring for someone at the end of their life, providing mouth care can be a very important part of making sure they are comfortable. It can also help to keep you involved in their care.
An unhealthy mouth can make it difficult for someone who is terminally ill or has a progressive disorder to eat, drink, or talk.
An unhealthy mouth can be very sore, dry or infected.
How to provide mouth care
Anyone can perform mouth care, including whānau and caregivers. You should provide mouth care:
- every 2 hours during the day
- once or twice at night if needed.
Check for:
- redness
- swelling
- sores
- white patches
- bleeding
- pain and dryness.
If you notice any changes, contact their healthcare provider.
Cleaning the person's mouth
Before you start, make sure the person is sitting up or lying on their side. This protects their airway. You will need:
- 2 to 3 mouth swabs (oversized cotton buds or a very soft toothbrush).
- A salt and baking soda mouthwash. Dissolve half a teaspoon of salt and half a teaspoon of baking soda in 200 ml of water, and make it fresh every day and keep it in the fridge.
- A toothbrush and toothpaste (if the person you are caring for has teeth).
What to do
Make a salt and baking soda mouthwash by mixing half a teaspoon of salt and half a teaspoon of baking soda in 200 ml of water. Make it fresh every day and keep it in the fridge.
Make a salt and baking soda mouthwash by mixing half a teaspoon of salt and half a teaspoon of baking soda in 200 ml of water. Make it fresh every day and keep it in the fridge.
Dip the swab in mouthwash and squeeze out any excess fluid.
Dip the swab in mouthwash and squeeze out any excess fluid.
Wipe one area of the mouth with the swab.
Wipe one area of the mouth with the swab.
Throw away the used swab and repeat in the next area of their mouth.
Throw away the used swab and repeat in the next area of their mouth.
If the person you are caring for has teeth, use a pea-sized amount of toothpaste and no water to limit the amount of foam and increase the cleaning action of the toothpaste.
Relieving dry mouth and soreness
People can experience symptoms like dry mouth and soreness at the end of their life. Regularly cleaning and moistening their mouth can help to prevent these symptoms.
Dry mouth
Using swabs in water or other liquid can help to moisten the person's mouth and lips every one to 2 hours. Use fluids or very soft foods that are familiar to the person you are caring for. For example, you can use:
- cool tea or coffee
- fruit juice
- fizzy drink
- cool, clear soup
- ice cream
- yoghurt.
Avoid iced water, as this can be a shock, especially if someone has sensitive teeth.
If the person is drowsy or unconscious, familiar fluids and the touch of a family member can lessen the shock of having something placed in their mouth. If the person usually drinks a lot of alcohol, swabbing their mouth with alcohol might keep them more settled.
Keep their lips moist with petroleum jelly (Vaseline) or lip salves.
Sore mouth
Take particular care if you loved one's mouth is painful or has ulcers. Consider using choline salicylate gel (Bonjela), which you can buy from a supermarket or pharmacy.
If their tongue becomes sore, red or covered with a fuzzy coating, they may have oral thrush (candida). Tell their healthcare provider if you notice this. It can be easy to treat with antifungal drops.