Keeping a patient’s mouth moist, clean and comfortable when they are nearing end of life is a vital part of care. Carolyn Doyle, RCN professional lead for end of life care, talks us through what you need to know:
The basics
Mouth care should always be carried out if it can be tolerated by the person:
- Explain clearly what you’re going to do.
- Be aware of any swallowing problems.
- If you need to leave dentures out of the mouth to improve mouth comfort, explain to the person being cared for and ask for consent to do this. Explain why you’re doing this to family members too, as they may not have seen their relative without dentures.
- Encourage independence as much as possible, or support someone to participate in their own mouth care where they are able to.
- Support families and carers to provide mouth care if they wish to.
- When appropriate, encourage patients, residents and their relatives to bring in their own toothpaste, toothbrushes and other products.
- Use a light source to look in the mouth. Without this, it’s easy to miss areas, particularly the roof of the mouth.
The importance of cleaning
Help to keep the mouth moist and hydrated:
- Use a water-based lip balm as often as needed to keep the lips moist.
- Use a small-headed soft-bristled toothbrush.
- A mild flavoured toothpaste or a non-foaming toothpaste may be better tolerated during end of life. A pea-sized amount or a smear is sufficient.
- If toothpaste can’t be tolerated, use a small amount of water on a toothbrush to remove debris and plaque.
- Gently clean the teeth, cleanse the gums, cheeks, tongue and palate.
- Ensure dentures are removed and cleaned thoroughly twice daily.
- If using a spray, ensure the water is not sprayed towards the back of the mouth. A referral should always be sought from a speech and language therapist to ensure the patient is not at risk of aspiration. This action can be carried out throughout the day and will help to keep the mouth moist and hydrated.
- You can also use a dry mouth gel.
Assessment and documentation
Record keeping is essential:
- Assess the mouth for any changes using a mouth care assessment form.
- Speak to a member of the clinical team if you note any changes or have any concerns. Make sure this is documented.
‘It makes a difference’
"I’d usually have an enabling role in supporting patients perform mouth care, but if patients can’t carry out their own mouth care, for example when they are reaching the end of their lives, I step in. It is a rewarding role and it makes a difference. It helps patients look and feel cared for.
"It’s no longer unusual to have patients at the end of their lives on the respiratory ward where I work, as specialist end of life wards have been repurposed as COVID wards where the single, private rooms can be used for isolating patients.
"But even if patients can brush their own teeth, we often have to remind them to do that. There’s so much going on for them while they are being cared for on our ward, it may not be their priority."
Find out more
- Download the RCN guides Mouth Care Matters in End of Life Care and Mouth Care at the End of Life.
- View the Health Education England resource on mouth care at the end of life here.
