This summarises the best practice for mouth care for terminally ill residents, and is designed to minimise discomfort and maximise dignity:
Where a resident has been diagnosed as approaching the end of their life, a programme of palliative care will be put into practice, to ensure that the resident is made as comfortable as possible and continues to be treated with dignity and respect. Staff will not unduly emphasise the resident’s condition, and discretion will be paramount.
End of life planning will be fully documented in the Resident’s Plan of Care and reviewed regularly as their condition changes.
The mouth is a primary area of sensation and taste and touch are equally important at the end of life as at the beginning. Where oral hygiene is neglected, the mouth rapidly becomes dry, sore and infected. The tongue becomes coated and the breath foul smelling. Similar effects may also be created by breathing difficulties, dehydration, some types of medication or a combination of some or all of these factors. Good hydration and pain control will promote good oral health.
A dry mouth can be alleviated with very cold drinks or sucking ice cubes, and sparkling water makes an effective mouth wash. Care should be taken with the use of proprietary mouth washes as these can be counterproductive and may change the ph balance of the mouth, (acidity level), creating a breeding ground for fungal infection such as ‘thrush’.
Where lips are dry a proprietary brand of lip salve can be used or plain petroleum jelly (Vaseline) applied.
At the end of life an individual may find it difficult, or be unable, to tolerate oral fluids, and the key objectives for mouth care will be:
To maintain as comfortable a condition as possible maximising all remaining ability of the resident to undertake or participate in their own mouth care (see practice guideline 143)
To maintain a clean, moist mouth
To prevent infection that might be related to poor oral hygiene
To encourage the ability to eat and drink where this may be possible
Mouth care should be undertaken at least hourly, and more frequently if necessary.
Where dentures are in situ, these should be removed and cleaned at least twice daily and removed and soaked in a denture cleaning solution overnight. They must be rinsed before being replaced in the mouth.
For as long as the individual is able, s/he should be assisted to use a toothbrush and toothpaste, with close attention being paid to the size and shape of the brush. A child sized brush and flavoured toothpaste may be effective in creating a pleasant taste in the mouth.
Always ask the person to open their mouth, but if they are unable to co-operate do so gently, ensuring fingers are kept clear of the teeth and tongue
Using fresh water, which may be chilled if appropriate, dip the sponge into the water and then allow the excess water to run off before placing the sponge in the mouth. If a water loaded sponge is placed in the mouth of an individual who has difficulty swallowing, the water may run down the trachea and cause the person to cough or choke. It may be necessary to use more than one sponge
Gently brush the front of the tongue avoiding the back as this could cause ‘gagging’.
Ensure the person’s face is dry
Discard the sponge and protective equipment
5. Use of Mouth Sponges
Mouth sponges must NEVER be left soaking in water. This may cause them to become loose on the stick and detach in the mouth, creating a risk of choking. Sponges should only be removed from packing immediately prior to use and should be stored in a covered container or packet to ensure they remain clean until use.
The state of the mouth should be recorded with each clean. If there is any indication that the mouth may be excessively dry or the condition of the tongue and teeth appear to be coated, this should be reported to the GP to enable exclusion of possible infection, or adjustment of medication.