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Effective oral hygiene and denture care are crucial for patients’ health, and a fundamental nursing responsibility. This article describes principles and techniques of good mouth care

Oral care is a fundamental part of nursing care and failure to provide it can have a negative effect on health and wellbeing. This article explains the procedure for oral and denture care.

Citation: Otukoya R, Shepherd E (2018) Principles of effective oral and denture care in adults. Nursing Times [online]: 114: 11, 22-24.

Authors: Rachael Otukoya is a dentist in special care dentistry and dental public health at East Surrey Hospital; Eileen Shepherd is clinical editor, Nursing Times.

Oral health is essential to good health and quality of life, and is defined by the World Health Organization (2018) as “a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing”.

Maintaining patients’ oral hygiene is an essential nursing duty and is considered a fundamental aspect of care (Department of Health, 2010). Evidence suggests that oral health deteriorates while people are in hospital (Terezakis et al, 2011) and it is generally acknowledged that mouth care in hospitals and care homes needs to be improved (Binks et al, 2017). Barriers to providing effective oral care include:

In response to concerns, in 2015 Heath Education England launched Mouth Care Matters to improve oral care for adults in care homes and hospitals (Box 1).

The Mouth Care Matters initiative states that staff need to have:

There are many reasons people may have poor oral hygiene, including:

Providing effective mouth care to patients can:

Teeth should be brushed at least twice a day with a fluoride toothpaste (Public Health England, 2017; National Institute for Health and Care Excellence, 2016). They should always be brushed last thing at night.

In hospital and care homes frequency can be determined using an oral assessment tool and depends on individual need. Patients receiving oxygen therapy, nil by mouth or those who are vomiting will require frequent mouth care. Nurses should prompt and support patients to carry out oral care and undertake oral care for those who cannot maintain a clean mouth for themselves (NICE, 2016).

A pen torch and tongue depressor can make it easier to see inside the oral cavity. The assessment will:

Fig 1 details the features that will be evident in a healthy oral cavity. Oral assessment will help to identify issues such as:

The patient should be referred to a dental professional if there are concerns about excessive plaque, ill-fitting dentures or multiple/long-standing ulcers.

In 2012 the Medicines and Healthcare products Regulatory Agency issued an alert advising that foam swabs should not be used with patients as the foam heads can become detached (MHRA, 2012). Many organisations have subsequently banned them on patient safety grounds. They are not as effective as a toothbrush at removing dental plaque and should not be used as a replacement for toothbrushes (Pearson and Hutton, 2002).

Good denture hygiene is essential as food and debris can collect under dentures. Denture care reduces the risk of developing problems such as oral thrush.

Loss of dentures is a major problem in hospital and affects patients’ ability to eat and communicate, and may also affect their psychological wellbeing (Binks et al, 2017). Obtaining new dentures is expensive and inconvenient for patients.

Mouth Care Matters identifies three key principles for denture care (Doshi, 2016):

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