Is Oral Care Needed When Someone Can’t Eat? Why It Matters Most for People Who Don’t Eat by Mouth

Written by: 三好 早苗 (Dental Hygienist)

Do you know what “oral care” actually involves?

When they hear “oral care,” most people probably think of brushing teeth with a toothbrush. But oral care is not just about brushing teeth and keeping the mouth clean. It also means drawing out the functions of the mouth, such as speaking, eating and making facial expressions.

Besides brushing, oral care includes cleaning the tongue and the mucous membranes (such as the inside of the cheeks and the gums) with special brushes, and massaging and stretching the muscles around the mouth and of the tongue. Some care facilities do mouth exercises before meals as part of oral care. Oral care has been reported to help prevent aspiration pneumonia and influenza.

Older people who need care tend to have weakened oral function and unclean mouths. Even those who brush their own teeth can’t brush well if they have paralysis or advanced dementia. Older people, whose immunity tends to decline, also need oral care to prevent infections.

Do people who can’t eat not need oral care?

Family members of people who don’t eat by mouth sometimes ask me, “Their mouth isn’t getting dirty, so is it all right not to brush?” But this is a misunderstanding.

When a person doesn’t eat by mouth, there is no stimulation from chewing, so less saliva is produced and the mouth becomes dry. And with less saliva, the mouth’s natural self-cleaning action weakens, so the mouth gets dirty.

Many kinds of bacteria naturally live in the mouth, but when the mouth gets dirty, the bacterial balance is upset and bacteria multiply further. In other words, the less a person eats by mouth, the drier and dirtier the mouth becomes, and the more bacteria multiply. That is why people who can’t eat need frequent oral care all the more.

Case: What a daughter could do for her father until the end

Yoshio, a man in his 80s, became bedridden after a bout of pneumonia. He could no longer speak or eat, and his home-care physician had told the family that he did not have long to live.

His only daughter, Yuri, in her 50s, agonized: “What on earth can I do for my father now that he can’t do anything?”

One day, a dental hygienist who came on a home dental visit asked her, “Yoshio’s mouth is extremely dry, so he needs frequent oral care. Could you help?”

Yuri wondered, “He can’t even eat anymore, so why does he still need oral care?” But the dental hygienist explained that the dryness had allowed bacteria to multiply in her father’s mouth, and that phlegm and debris from the mucous membranes had caked on, making it hard for him to breathe.

Yuri learned how to provide oral care from the dental hygienist, and four or five times a day, with a sponge swab and moisturizer in hand, she worked to keep his mouth moist.

At first Yuri was afraid of doing oral care, but she gradually learned the method and timing, and began consulting the dental hygienist, who visited once a week, about how dry his mouth was and changes in his breathing.

The dental hygienist and Yuri continued oral care for about a month and a half. After Yoshio passed away, Yuri told us, “I’m glad there was something I could do for my father right to the end.” Through oral care, she felt fulfilled at having been able to care for her father until the very end.

Choose oral care products to suit the condition of the mouth

The most important point in oral care is to choose products suited to the condition of the person’s mouth and to provide appropriate care.

Today, many oral care products are sold at drugstores and online. But if you don’t understand what each one is for and how to use it, half the benefit is lost.

Sponge swabs

The sponge swab Yuri used is a stick with a small sponge on the end, used to remove debris from the mucous membranes. Sponge swabs cannot remove plaque (clumps of bacteria) from the teeth, so if the person still has teeth, a toothbrush must also be used.

Moisturizers

If the mouth is dry, use an oral moisturizer. Starting oral care while the mouth is dry can damage the mucous membranes, so moisturize before care. Oral moisturizers come in many types, such as gels and sprays.

For Yoshio, a spray moisturizer was used. Sprays are easy to use even for people doing oral care for the first time. However, they moisturize somewhat less well than gels, so care needs to be more frequent.

In this way, it is also important to decide on products and frequency based on the condition of the person’s mouth and the caregiver’s skills.

Start by consulting a dentist or dental hygienist

Just as everyone’s face is different, the condition of each person’s mouth is different. With older people in particular, conditions are diverse and complex: some wear dentures, some have loose teeth from advanced gum disease, some still have many teeth, and some have trouble opening their mouths. It is no exaggeration to say that almost all older people have some kind of problem in the mouth.

When starting oral care, I recommend consulting your regular dental clinic, or a dentist or dental hygienist who makes home visits, about what to use and how, and getting their guidance.

It is still not widely known that people who can’t eat need oral care. Please remember that even when someone can no longer eat, they need care to keep the mouth from drying out and to prevent various infections.

And one day, everyone must face a time of parting. Surely every family hopes that their loved one can pass away peacefully, with as little suffering as possible. Please keep in mind that oral care can help with that, too.

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About the author: 三好 早苗 (Dental Hygienist)

This article is a contribution from a medical or care professional, re-edited by our editorial team. It provides general information as of the time of writing, and symptoms and circumstances differ from person to person. For specific decisions, please consult your doctor, dentist, pharmacist or another professional.

This is an English translation of a column originally published in Japanese by Next Co., Ltd.

About Next Co., Ltd. We are a Tokyo-based company working in Japan’s senior care and end-of-life planning field. Alongside these expert columns, we publish professional training textbooks and support businesses entering Japan’s eldercare market. More expert columns | Our English textbook | Contact us