In palliative care, mouth care is about comfort: keeping the mouth moist, clean and free of pain, and setting aside anything that does not help with that. A systematic review in BMC Oral Health found that dry mouth, oral thrush and difficulty swallowing are the most common mouth problems in people receiving palliative care. Many people at this stage cannot easily say their mouth hurts, so it helps when families and carers know what to look for.
Written by Dr James Tran, BDent (University of Sydney), MICOI, GradDip (Oral Implants), general dentist at Lumi Dental in Melrose Park.
The short version
- The aim changes from preventing future dental problems to keeping the person comfortable now.
- A soft toothbrush, moist swabs, frequent moistening and lip care cover most of what is needed.
- Products containing lemon, glycerine or alcohol can make a dry mouth drier or sorer, so Australian palliative care guidance advises avoiding them.
- If the person uses oxygen, avoid petroleum or oil-based lip products and use water-based ones instead.
- White patches, pain, bleeding, a bad smell or refusing food are worth reporting to the palliative care team or GP. Our article on oral thrush in adults explains one common cause.
- A dentist can help with a sharp tooth, a rubbing denture or tooth pain when the person is able to travel.
Why the mouth becomes uncomfortable
Several things tend to happen at once. Queensland Health's guide to mouth care in the last days of life notes that a dry mouth can be a sign of dehydration but is usually caused by breathing through the mouth. Oxygen therapy, thrush, earlier radiotherapy and many common medicines, including some antidepressants, antihistamines and strong pain relievers, add to the dryness. The palliAGED tip sheet for nurses describes a high rate of low saliva, mouth inflammation, ulcers and redness in people receiving palliative care.
The BMC Oral Health review found that a dry mouth affected speech and swallowing and was linked with shame and avoiding company. For more on why saliva matters, see our guide to dry mouth causes and treatment.
The single rule: comfort comes first
If a step keeps the mouth moist, clean or pain-free, keep doing it. If it causes distress and adds no comfort, it can usually be left out. In my experience, families often feel they are failing when they cannot brush as thoroughly as before, but a mouth that does not feel dry and sore matters more now than a perfect clean.
A gentle daily routine
Queensland Health and the palliAGED tip sheets describe a similar routine. How often you do each step depends on the person and what they can tolerate.
- Teeth or dentures: a soft toothbrush with a small amount of toothpaste, at least twice a day if tolerated. A baby toothbrush or one with a bendable handle can be easier to use.
- Tongue, gums and cheeks: an oral care sponge or swab moistened with water or saline, at least every four hours.
- Moisture in between: sips of fluid or ice chips if the person can swallow safely; a water mist spray if tolerated; a water-based gel or saliva substitute inside the mouth as needed.
- Lips: a lip balm the person likes, unless they are on oxygen (see below).
- What to avoid: lemon and glycerine swabs and alcohol-based mouthwashes, which can dry the mouth or cause pain.
Explain each step before you start, keep to a calm routine and stop if the person becomes distressed.
Lip care when oxygen is used
Home oxygen guidance from Bedfordshire Hospitals NHS Trust advises against oil, petroleum or paraffin based products, including petroleum jelly and oil-based lip balms, while oxygen is in use because of the fire risk. Water-based gels and lotions are suggested instead. Check the label, and ask the oxygen supplier or palliative care nurse if you are unsure.
When swallowing is difficult or the person is drowsy
This is the stage that families often find hardest. Queensland Health notes that the sight of a dry mouth in someone who can no longer swallow is a common cause of distress for families, and that nursing staff can suggest ways for family to help with mouth care if they would like to.
- Offer sips or ice chips only if the person can still swallow safely.
- Moisten the mouth, tongue and inside of the cheeks with a swab dipped in water, or a favourite flavour, and squeeze out the excess first.
- Consider positioning the person on their side while you give mouth care.
- A water-based gel inside the mouth can help the moisture last longer between swabs.
If you are unsure whether swallowing is safe, ask the palliative care nurse before offering anything by mouth.
Dentures: comfort before routine
A dry mouth can make dentures less secure, and a loose denture can rub and cause ulcers. The palliAGED careworker tip sheet suggests cleaning dentures with a denture brush morning and night, rinsing the mouth after meals and leaving dentures out overnight if that is what the person usually does.
If a denture is loose, sore or no longer wanted, it is reasonable to leave it out; some people still prefer to wear it for meals or visitors. Our article on denture cleaning tablets, soaks and brushing covers cleaning, and our guide on whether to sleep with dentures in explains the overnight question.
Signs to report, and who to tell
The palliAGED nurses' tip sheet lists signs of mouth or tooth pain in someone who cannot say it: not eating, losing interest in food, pulling at the face or mouth, chewing at the lip, tongue or hands, aggression and changes in activity. These can have other causes, but the mouth is worth checking.
| Problem | What it may look like | What may help | Who to tell |
|---|---|---|---|
| Dry mouth | Sticky tongue, cracked lips, difficulty talking | Frequent moistening, water-based gel, lip care | Palliative care nurse if it persists |
| Possible thrush | White or red patches, soreness, changed taste | Gentle cleaning, clean dentures daily | GP or palliative care team |
| Sore spots or ulcers | Wincing during care, refusing food | Soft brush, avoid lemon, glycerine and alcohol products | GP or palliative care team |
| Bleeding or bad smell | Blood on the swab, a new strong odour | Gentle swabbing rather than firm brushing | Palliative care team or GP |
| Loose or rubbing denture | Ulcer under the denture, pulling at the mouth | Leave the denture out | Dentist, if the person can travel |
| Sharp or broken tooth | Cut on the tongue or cheek | Careful cleaning around the tooth | Dentist |
If the person also lives with dementia, our guide to dental care for families and carers of people with dementia has more ideas for when mouth care is resisted.
When a dentist can help
Dental treatment in palliative care is usually short and practical: smoothing a sharp tooth, easing a denture that rubs or dealing with a painful tooth. I usually keep these visits brief and focused on the one problem bothering the person most.
A visit is easier while the person can still travel and sit in a dental chair, so it is worth raising mouth problems early. If travel or transfers are a concern, our article on wheelchair access and dental care covers what to ask before booking. If the person can no longer travel, the GP or palliative care team can advise on local options.
Looking after yourself as a carer
healthdirect notes that palliative care can happen at home, in hospital, in a hospice or in residential care, and that carer support can include information, training, emotional support and respite. Its palliative care page points carers to Carer Gateway for practical help.
How we approach this at Lumi Dental
Lumi Dental is a general dental practice at Melrose Central in Melrose Park, with on-site parking. When someone receiving palliative care is able to travel, a dentist can see them for a short, practical appointment in the chair to look at a sharp tooth, a sore or loose denture, or tooth pain, with the aim of comfort rather than extensive treatment. The team at Lumi Dental can write to the GP or palliative care team about what was found. Lumi Dental does not offer home visits. Read more about general dentistry at Lumi Dental.
Questions patients ask
How often should you do mouth care for someone who is dying?
Queensland Health suggests cleaning the mouth with a moist swab at least every four hours and brushing teeth or dentures at least twice a day if tolerated. Moistening can be more frequent if the mouth feels dry. The right frequency depends on the person.
Are lemon and glycerine swabs good for a dry mouth?
No. Australian palliative care guidance advises avoiding lemon and glycerine swabs and alcohol-based mouthwashes, because they can make dryness and soreness worse. Water, saline or a water-based gel are gentler choices.
Should dentures be left out at the end of life?
If a denture is loose, sore or unwanted, leaving it out is reasonable. If the person prefers to wear it for meals or visitors, keep it clean and take it out if it rubs.
How do you keep a mouth moist if the person cannot swallow?
Use a swab dipped in water and squeezed out, a fine water mist if tolerated, and a water-based gel inside the mouth. Offer sips only if swallowing is safe. The palliative care nurse can show you how.
Can a dentist visit someone at home?
Lumi Dental does not offer home visits. If the person can travel, a short appointment at the practice may help, and you can contact Lumi Dental to talk it through. If they cannot travel, ask the GP or palliative care team about local options.
Questions about mouth care for someone you look after? Talk to the team at Lumi Dental
If you are caring for someone receiving palliative care and have questions about their mouth, teeth or dentures, the team at Lumi Dental can help you work out what is worth doing and what can wait. Contact Lumi Dental to ask a question or arrange a short visit, or read more about general dental care in Melrose Park. Families come from Ryde, Parramatta, Ermington and Rydalmere, and parking is on site at Melrose Central.
Sources
- Queensland Health: Mouth care in the last days of life (comfort assessment and management fact sheet)
- palliAGED: Tips for Nurses, Oral Care
- BMC Oral Health (Venkatasalu MR and colleagues): Oral health problems among palliative and terminally ill patients, an integrated systematic review (PMC)
- Bedfordshire Hospitals NHS Trust: Home Oxygen Therapy Patient Information
About the author
Dr James Tran is a general dentist at Lumi Dental in Melrose Park. He holds a BDent from the University of Sydney and a Graduate Diploma in Oral Implants, and is a Member of the International Congress of Oral Implantologists (MICOI).
This article is general information only and is not a substitute for an examination and individual advice from a registered dental practitioner. Suitability for any treatment varies from person to person.
