Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed. Where possible, encourage patients to carry out their own oral care.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [162], C). To enable patients to gain confidence in managing their own symptoms (NHS England [144], C).
2. 2.Show
   Wash hands with soap and water and dry with a paper towel, or use alcohol‐based handrub. Put on disposable gloves.
   To reduce the risk of cross‐infection (NHS England and NHSI [148], C).

Procedure

1. 3.Show
   Prepare solutions required.
   Solutions must always be prepared immediately before use to maximize their efficacy and minimize the risk of microbial contamination (Bullock and Manias [28], E).
2. 4.Show
   If the patient cannot remove their own dentures, remove the lower denture first.

   1. Lower denture: grasp it in the middle and lift it, rotating it gently to remove it from the mouth. Place it in the denture pot.
   2. Upper denture: remove the upper denture by grasping it firmly in the middle and tilting the denture forward while putting pressure on the front teeth to break the seal with the palate. Rotate the denture from side to side to remove it from the mouth and place it in the denture pot.
    

   Removal of dentures is necessary for cleaning of underlying tissues and all surfaces of the dentures themselves (Birchenall and Streight [20], E).
3. 5.Show
   Carry out an oral assessment using an approved oral assessment tool. See Figure 9.15.
   To provide a baseline to enable monitoring of mucosal changes and evaluate the patient's response to treatment and care (HEE [82], C).
4. 6.Show
   1. Inspect the patient's mouth with the aid of a torch, spatula and gauze, paying special attention to the lips, buccal mucosa, lateral and ventral surfaces of the tongue, floor of the mouth and soft palate (see Action figure 9.18 in Procedure guideline 9.14: Mouth care).
   2. Ask the patient whether they have any of the following: taste changes, change in saliva production or composition, oral discomfort or difficulty swallowing.
   The mouth is examined for changes in condition with respect to moisture, cleanliness, infected or bleeding areas, ulcers and so on. These areas are known to be particularly susceptible to cytotoxic damage (HEE [82], C).

   To assess nutritional deficits, salivary changes and pain secondary to oral changes (HEE [82], C).
5. 7.Show
   Give a cup of water to the patient. Encourage the patient to rinse their mouth vigorously then spit the contents into a receiver. Paper tissues should be on hand to dry any spillage of water or dribbling.
   Rinsing removes loosened debris and makes the mouth taste fresher (Birchenall and Streight [20], E).
6. 8.Show
   Clean the patient's dentures on all surfaces with a toothbrush and soap and water or a denture cleaner. Check the dentures for cracks, sharp edges and missing teeth. Dentures should be removed for at least 1 hour but ideally overnight and placed in a suitable cleaning solution. Rinse them well and return them to the patient.
   Cleaning dentures removes accumulated food debris, which could be broken down by salivary enzymes to products that irritate and cause inflammation of the adjacent mucosal tissue (HEE [82], C).

   Dentures can easily become colonized by bacteria. Soaking can disinfect the dentures, discouraging bacterial growth (HEE [82], C).

Post‐procedure

1. 9.Show
   Discard remaining mouthwash solutions.
   To prevent infection (Bullock and Manias [28], E).
2. 10.Show
   Clean the toothbrush or denture brush and allow it to air dry.
   To prevent contamination (HEE [82], C).
3. 11.Show
   Remove gloves. Wash hands with soap and water and dry with a paper towel, or use alcohol‐based handrub.
   To reduce the risk of cross‐infection (NHS England and NHSI [148], C).
4. 12.Show
   Ensure the patient is comfortable.
   To maintain patient comfort and dignity (NMC [162], C).
5. 13.Show
   Ensure the dentures and container are clearly labelled.
   To ensure the dentures are kept safe. E