General points | Right Decisions

All patients

Oral care is most effective when the patient can be in a semi-upright position to avoid choking or aspiration of bacteria or debris. When positioning is not possible, care should be taken to avoid collection of fluids in the oral cavity or aspiration.
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 (refer to section on dry/coated mouth care).
Gentle tongue brushing should also be encouraged to reduce halitosis and prevent tongue coating.
Encourage fluid intake with frequent, small drinks.
Apply †water-based gel to dry lips after oral care.
Where possible reduce intake of sugary foods and drinks between meals (refer to Anorexia/cachexia guideline). There may be additional oral care requirements as frequency of intake increases.
Where there is concern about oral intake and nutrition, consider referral to a dietitian with consent.
Encourage and support family members who wish to participate in carrying out mouth care.

Clean natural teeth with fluoride toothpaste (1350 to 1500ppm fluoride) after every meal, but at least twice daily if tolerated.
Mechanical brushing of teeth and gums to remove plaque and debris is as important as application of toothpaste or chlorhexidine digluconate 1%w/w dental gel.
Encourage patients to spit out excess toothpaste after brushing.
The mouth should not be rinsed with water after brushing.
Remove partial dentures and clean separately.
A dental hygienist or dentist can provide professional advice on oral hygiene for those with complex dental needs.
Very soft toothbrushes (for example silk toothbrush or baby toothbrush) can be used to perform oral daily care for patients with a painful mouth.

Mark all dentures with the patient’s name.
A denture fixative may provide relief from extensive movement of dentures.
Brush dentures at least twice a day over a sink of water to guard against splashing and prevent them from breaking if they are dropped.
Use of a personal toothbrush and running water are adequate for the physical cleaning of dentures. Denture cream or unperfumed soap may be used but not regular toothpaste.
Rinse dentures thoroughly after meals and before replacing in the mouth.
Remove dentures at night and soak in a suitable cleansing solution for
20 minutes, then overnight in plain water. Recommended soaking solutions are :
- dilute sodium hypochlorite solution for plastic dentures
- chlorhexidine gluconate 0.2% solution for dentures with metal parts.
Check dentures for cracks, sharp edges and missing teeth daily.

Refer to local cancer centre/cancer network guidelines.
Patients may be advised to avoid anti-pyretic analgesics (paracetamol, aspirin) if at risk of neutropenia as this can mask fever due to sepsis.
Patients receiving head and neck radiotherapy should avoid oil-based products.

Include mouth care in the patient’s care plan.
Encourage family members who may wish to participate in mouth care activities with guidance and support from the team looking after the patient.
Consider changing or stopping medicines that are causing a dry mouth.
Carry out mouth care as often as necessary to maintain a clean mouth.
In people who are conscious, the mouth can be moistened every 30 minutes with water from a water spray or dropper or ice chips can be placed in the mouth.
In unconscious people, moisten the mouth frequently, when possible, with water from a water spray, dropper, or sponge stick or ice chips placed in the mouth.
To prevent cracking of the lips, a water-soluble lubricant should be applied.
When the weather is dry and hot, if possible, use a room humidifier or air conditioning.
Ensure help is offered to clean teeth or dentures.
Manage oral pain symptomatically, using analgesics via a suitable route.
Stop treatment of the underlying cause of oral pain when the burden of treatment outweighs the benefits.