COVID 19 - Mouth care advice for hospitals during the pandemic

Everyone is entitled to high quality mouth care as part of a daily routine as laid out in the Health and Social Care Standards. It is an important aspect of care for the hospital patient and essential during palliative care.

Please be reassured mouth care is not an aerosol generating procedure.

Dental plaque accumulates rapidly in the mouths of critically ill patients and increases the risk of aspiration pneumonia.  Plaque still forms in the mouths of people on nil-by-mouth, PEG-feeding and oxygen therapy.

PPE for delivering mouth care to patients
  • Single use disposable apron

  • Single use disposable gloves

  • Fluid resistant face mask

  • Eye/face protection

Please follow the PPE guidance in your hospital area/ward.  You may have enhanced PPE requirements beyond those detailed above.

Further information on PPE for hospitals can be found in the guidance from Health Protection Scotland,  https://www.hps.scot.nhs.uk/a-to-z-of-topics/covid-19/ and local advice will be available from your hospital’s infection control team.

Assessment of the mouth

This is required to ascertain the type of mouth care required and is dependent on whether a patient has natural teeth, dentures or a mixture of these.

Mouth care for patients

Encourage continued independence for patients who are able to undertake their own oral care through their illness and recovery period.  

All Patients

  • Looking after oral soft tissues is just as important as looking after the teeth.

  • Keep mouth and lips clean, moist and intact by removal of plaque and debris.

  • Gentle tongue brushing should also be encouraged to reduce halitosis and prevent tongue coating.

  • In the unconscious patient, wetted nonfraying gauze wrapped around a gloved finger can be used to remove debris.

  • Apply water-based gel to dry lips after oral care.

  • Good hydration is essential.

Ventilated Patients

  • Effective oral hygiene is important for ventilated patients to reduce ventilator-associated bacterial pneumonia.

  • Consultation with the nurse in charge is essential prior to commencing mouth care.

  • Clean teeth and gums with chlorhexidine mouthwash or gel, using a toothbrush or gauze.

  • Lubricate lips regularly with water-based saliva replacement gel or aqueous cream (petroleum gel should not be used in the  vicinity of oxygen).

  • Perform regular mouth and pharynx suction to reduce build-up of secretions.

Patients with natural teeth

  • Remove any partial dentures first and clean separately.

  • Clean natural teeth with fluoride toothpaste at least twice daily if tolerated.

  • Mechanical brushing of teeth and gums is necessary to remove plaque and debris.

  • If they are able to, encourage patients to spit out excess toothpaste or remove foam with gauze.

  • The mouth should not be rinsed with water after brushing.

  • Very soft toothbrushes can be used for patients with painful soft tissues.

Denture care

  • Brush dentures at least twice a day over a sink of water to guard against splashing and prevent breakage if dropped.

  • A toothbrush and running water are adequate for the physical cleaning of dentures. Denture cream or unperfumed soap may be used but not regular toothpaste.

  • Remove dentures at night and soak in a suitable cleansing solution for 20 minutes, then overnight in plain water. Recommended soaking solutions are:
    o dilute sodium hypochlorite solution for plastic dentures.
    o chlorhexidine solution for dentures with metal parts.

  • Check dentures for cracks, sharp edges and missing teeth daily.

 

End of life mouth care

In the event that a patient reaches the end stages of life, keeping their mouth moist and comfortable is the main aim of mouth care.

  • Continue to carry out mouth care if it is not causing distress.

  • If the patient has a dry mouth, hydrate with a toothbrush dipped in water or apply a dry mouth product to the tongue, inside of their cheeks and roof of mouth.

  • Keep the patient’s lips moist with water-based gels.

Additional Information

Additional information on looking after a patient’s mouth is available on Turas Learn at https://learn.nes.nhs.scot/28872/oral-health-improvement-for-priority-groups/covid-19-mouth-care-for-the-critically-ill-patient 

The information includes care of dry mouth, management of pain relating to soft tissues and references to websites with more information such as the Scottish Palliative Care Guidelines.

Please follow local health board pathways to access emergency dental care if you have concerns about a patient’s mouth.

 

Updated 29/04/2020