Good oral health is important to quality of life and wellbeing. Some residents are particularly at risk of poor oral health and diseases of the mouth. This includes residents with severe dementia, those unable to express needs, or who are dependent on staff for assistance with ADL’s.
Many medications commonly prescribed to older people are known to cause dry mouth (xerostomia) and some diseases cause alterations in saliva. A dry mouth is uncomfortable and contributes to tooth decay, gum disease and oral thrush.
A recent review  of treatments for xerostomia found that there was a lack of well-designed trials of products to treat dry mouth. They concluded that OGT spray is more effective than an electrolyte spray. An integrated mouth care system using toothpaste, gel and mouth wash showed promise. There was no information on acceptability to patients or on use with cognitively impaired persons.
Poor oral and dental health is associated with:
- pain and behavioural disturbances
- increased risk of respiratory infection
- swallowing and nutritional problems, and
- speech difficulties.
Behavioural signs of oral and dental pain may include:
- not eating
- decreased interest in food
- pulling at face or mouth
- chewing at lip tongue or hands
- aggression, and
- alteration in activity levels. 
Families are distressed when their loved ones oral care needs are not met. They see the quality of oral care as a marker for the general care that their loved one receives.
In the RAC, registered nurses are responsible for assessing, planning and evaluating oral care whilst careworkers are expected to carry out oral care. There is concern that nursing education does not prepare nurses adequately for their role in oral care. Careworkers may not recognise the importance of their role in maintaining oral health of residents.
Recent projects in RAC (Better Oral Health in Residential Care, Palliative Approach Toolkit) have successfully addressed these issues using education, fact Sheets and assessment tools.
Oral care can be improved if:
- staff have specific and practical education in oral hygiene
- staff use an assessment tool to systematically assess, plan and evaluate oral care
- residents have access to mobile dental services
- there is management support for, and promotion of, an oral care program
- the RACF has an oral care champion.
Mouth care recommendations include:
- brushing natural teeth twice daily with a small soft toothbrush for 2 minutes
- always rinse after using toothpaste as residual toothpaste contributes to oral dryness
- avoid products containing lemon juice, glycerine, alcohol or alcohol products as they increase mouth dryness and may cause pain
- foam sticks are only suitable for comfort measures and do not adequately remove plaque or debris.
- there is a potential for foam heads to be detached from sticks and become a choking hazard
- minimise risk by:
- always check that foam head is securely attached to the stick before using
- never use a stick that has been left to soak in solution.
Providing mouth care at the end-of-life can promote comfort by relieving xerostomia and easing the discomfort of terminal dehydration.