Oral care for frail elderly

Oral care method

  1. General Procedures
    • Caregivers should wash their hands both before and after providing oral care to the elderly and put on disposable gloves during oral care procedures.
      Photograph of washing hands with water

      Photograph showing hands put on with a pair of new gloves

    • To protect the clothing of the elderly from getting wet, cover the body with a towel or a plastic sheet. When providing oral care to the elderly who are being bed rest, if possible, let the elderly to sit upright with pillows behind his/her back for support, and if necessary use a suction to remove saliva to prevent aspiration.
      Photograph of the elderly sitting with pillows behind her back facing her caregiver.

    • If there are any wounds or abnormalities present in the elderly's mouth, caregiver should take the elderly to see the dentist.
    • Use different tools to clean the elderly's mouth according to his/her oral condition.
    • When cleaning the tooth surfaces that near the tongue or palate of the elderly, the tools such as toothbrush and gauze may touch the sensitive area on their throat causing gag reflex. Caregivers should let the elderly to take a rest first and avoid putting the toothbrush or gauze into that area again.
    • Before providing oral care to the elderly, caregivers should tell the elderly to put up their hands if they are feeling unwell. By the time, caregivers should let the elderly to rinse their mouth and take a rest first before start again.

  2. Cleaning the mouth for different elderly
    1. Cleaning the mouth for conscious elderly with natural teeth
      Caregivers should help the frail elderly with natural teeth to brush their teeth in the morning and at night, by using less amount of toothpaste.

      Materials:
      Toothbrushing Toothbrush, fluoride toothpaste, a glass, water, a small basin, towel or plastic sheet, disposable gloves, glycerine and cotton buds (for the elderly with dry or cracked lip)
      Clean interdental surfaces Floss holder, interdental brush, single-tuft toothbrush

      Photograph showing the oral cleaning materials for the elderly

      Procedures:
      • Sit in front of the elderly, and remove his/her denture(s). Then check his/her oral cavity to see if there are any wounds or abnormalities present. Clear the food debris inside the oral cavity. Use your hand to hold the elderly's chin to support his/her head. To prevent aspiration, do not force the toothbrush into his/her mouth. Perform toothbrushing for the elderly using the regular brushing method same as for everyone else.

        Photograph showing how the caregiver brushes the elderly's teeth by holding the elderly's chin
         
      • If the elderly lost some of his natural teeth, use single-tuft toothbrush to brush around the tooth and along the gum margin

        Photograph showing how the caregiver brushes the elderly's teeth with a single-tuft toothbrush
         
      • After toothbrushing, use floss holder and interdental brush to clean the interdental surfaces of the teeth for the elderly.

        Photograph showing the use of interdental brush to clean wide interdental space for the elderly

        Photograph showing the use of floss holder to clean narrow interdental space for the elderly
         
    2. Cleaning the mouth for conscious elderly without natural teeth
      Caregiver should swab the mouth for the frail elderly every night.

      Materials:
      Tweezers, gauze, a glass and water

      Procedures:
      Use tweezers to hold a piece of gauze
      Soak the gauze with water and squeeze out excess water.

      Photograph of the caregiver holding a tweezer with a piece of gauze

      Swab the cheek first, and then swab the other parts of the oral cavity in sequence of gum of upper arch, gum of lower arch, palate, top surface of the tongue, beneath the tongue and lip. Each area should be cleaned twice with clean gauze each time.

      Photograph showing how to use a piece of gauze to clean the oral cavity for the elderly

    3. Cleaning the mouth for frail elderly who has lost consciousness, unable to cooperate and has difficulty in swallowing
      Take care of this kind of elderly, caregivers should not use toothpaste. It is enough for the caregiver to apply the basic tooth brushing method and use floss holder, interdental brush or single-tuft toothbrush to clean interdental surfaces of the teeth. Besides, as the elderly cannot rinse, caregiver should swab the teeth and other areas in the mouth after toothbrushing. If the elderly you care for has no natural teeth, swab the oral cavity with wet clean gauze is enough.
       
  3. Cleaning of Dentures
    At night, caregiver should clean the denture(s) for the elderly. When remove it from the mouth of elderly, to prevent the clasps or other parts of the denture from traumatizing the soft tissue of oral cavity, caregivers should gently retract the cheeks of the elderly to enlarge the space and take out the denture by rotating it. Use toothbrush and detergent to clean every part of the denture, then rinse the denture and soak it in a glass of water overnight. Put back the denture in the elderly's mouth in the next morning.

    Photograph showing the use of toothbrush and detergent to clean the denture
     
  4. Cleaning of the mouth corners
    If the elderly have deep wrinkles formed in the mouth corners, the wrinkles will be extended from the mouth corner to the chin. As these folds trap and hold saliva, the caregivers should clean these folds for the elderly with wet towel or wet cotton buds to prevent inflammation.

Clean all the oral hygiene equipments thoroughly after using.