Mouth problems are common in people living with a terminal illness. They can be related to treatments like chemotherapy or radiotherapy.
Keeping someone's mouth and teeth clean may prevent problems like a sore or dry mouth. On this page we explain how to care for someone's mouth and teeth to reduce their risk of problems. If you're living with a terminal illness, you may also find the information on this page useful.
Why mouth care (oral hygiene) is important
People living with a terminal illness have a greater risk of developing mouth problems. For example, dry mouth (also called xerostomia) affects over 80 in 100 (almost 84%) people being treated for advanced cancer.
Having mouth problems can be uncomfortable and may affect how well someone can eat or swallow. It can matter to us how our mouth looks, so if someone's mouth looks sore or dry, it may also affect their communication. And it may lead to feelings of low mood.
Good mouth care can help stop bacteria building up. And this may help prevent problems like dry mouth, infection or a sore mouth. It's why mouth care is important for someone living with a terminal illness.
Getting support with mouth care from a healthcare professional
If you are given specific mouth care advice from a healthcare professional, follow their advice. This is very important if someone's had surgery or radiotherapy on their head or neck because these treatments can cause specific mouth problems.
If someone is having chemotherapy or radiotherapy, they should have a pretreatment oral assessment. This is when a member of the dental team at the hospital examines the person's teeth and mouth. If there's anything that needs treating, they will do this before they start chemotherapy or radiotherapy. This is to reduce the risk of any problems, like an infection, being made worse by their cancer treatment. The hospital will usually arrange this, but you can ask the person's doctor about it too.
Seeing the dentist at home
If possible, someone who has a terminal illness should have regular dental check-ups. If they're staying in a hospice, hospital or care home then you can ask a healthcare professional (or the care home manager) to organise this.
If they're at home and they cannot get to the dentist, a dentist may be able to visit them. To find out more about the community dental care in your area, visit:
How to brush natural teeth
The most important part of mouth care is brushing your teeth. If someone can brush their teeth themselves, they can use this information − or you can use it to support them.
How often to brush teeth
- Try to brush teeth twice a day for at least two minutes.
- If someone's mouth is sore or it's uncomfortable, then they should just do as much as they can.
- If possible and it's not uncomfortable, brush teeth after every meal too.
Toothbrush
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A soft, small-headed toothbrush such as a baby toothbrush or a silk toothbrush is best if someone's mouth is sore.
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Change the toothbrush every three months.
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Change it sooner than three months if:
- the brush is out of shape
- the person is having chemotherapy or has a suppressed immune system
- they've had a mouth (oral) infection.
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An electric toothbrush can be very effective and may be less tiring to use. The head of the toothbrush should be replaced every three months (or sooner) for the same reasons as above.
Toothpaste
- Use a small amount of toothpaste.
- It may be more comfortable to use a 'sore mouth' toothpaste or a child's toothpaste with fluoride.
- For some people who are near the end of life, the strong mint flavour and foam of many toothpastes can be uncomfortable. They're caused by an ingredient called sodium lauryl sulphate or SLS. It may be better to choose a toothpaste without SLS and with a mild taste. These are sometimes called non-foaming toothpastes.
- If it's too uncomfortable to use toothpaste or a toothbrush, then it's still possible to clean teeth using just water.
Mouth rinsing and mouth wash
Rinsing your mouth after brushing is not necessary. But if someone wants to do this, they can:
- rinse with fresh water
- rinse with a saline solution (one teaspoon of salt in a pint of water)
- use a mouth wash recommended by their doctor, district nurse or dentist.
Some people find that rinsing their mouth with a saline mouth wash after every meal helps to reduce their risk of infections or mouth ulcers. You can ask the doctor or nurse if this could be helpful.
How to clean false teeth and dentures
Clean dentures at least once a day, most importantly at night. You can use the information we have here – or ask the person's dentist for advice if there's anything you're not sure about.
- After taking dentures out, hold them under cold running water to get rid of any bits of food.
- Brush them using a large toothbrush or denture brush. You can use water, soap and water or a denture cleaner but not ordinary toothpaste.
- Always rinse dentures thoroughly with cold running water before putting them back in the mouth.
- Ideally, you can take dentures out after every meal to keep the person's mouth clean. Rinse them under running water and check for any bits of food left in their mouth before putting them back in.
- Remove dentures at night and clean them with a soft toothbrush and unperfumed soap or denture toothpaste. Soak dentures overnight. If you're not sure how to soak someone's dentures, check with their dentist because it depends on whether they have plastic dentures or dentures with metal parts.
Helping someone to brush their teeth who is less mobile or in bed
The person you're caring for may need your help to get to a sink. They may also need help with brushing their teeth.
If someone cannot get out of bed, you may need to help them sit up to clean their teeth. If they cannot sit up, ask their GP or district nurse for advice.
You will need:
- a bowl filled with water
- a soft small-headed toothbrush
- a tube of fluoride toothpaste
- mouthwash and soothing gels, if they use them
- a towel.
If they need your help with brushing, try to be gentle but thorough. Remember to clean the back teeth and the gums.
Helping someone who is less mobile with dentures
The person you're caring for may need help with taking their dentures out, cleaning them and storing them overnight (see How to care for false teeth and dentures above).
Mouth problems
The type of mouth problem that someone may have if they're living with a terminal illness include:
- dry mouth
- mouth pain
- redness
- swelling
- ulcers or other sores
- white patches on the mouth or tongue – this can be a sign of an infection like oral thrush (also called candidiasis)
- bleeding
- difficulty cleaning their teeth or dentures
- any other mouth problems such as changes in taste, difficulty chewing, swallowing and speaking.
Speak to a healthcare professional if someone has any of these. A healthcare professional can look into what's causing the problem and may be able to prescribe medication. If mouth problems are making it difficult for them to swallow pills, they may prescribe liquid medicine or medicines that dissolve in water.
If it's painful or too difficult to eat solid food, the doctor or nurse can give advice about liquid food supplements.
Dry mouth
Having a dry mouth (also called xerostomia) can feel uncomfortable and make it more difficult for someone to eat, drink or talk. You can use these tips to help keep someone's mouth and lips moist.
Eating and drinking with dry mouth
- Help them to take regular sips or sprays of water or other cold, unsweetened drinks.
- They could also suck on ice cubes, ice chips or ice lollies.
- Chewing sugar-free gum or sucking sugar-free sweets can help produce saliva.
- Try to avoid acidic or sugary food or drink (like fruit juices) if the person has their own teeth. These foods and drinks can cause tooth decay.
Gels, sprays and products for dry mouth
- Ask the person's doctor or pharmacist about saliva substitute sprays and gels. Some of these use substances from animal products so they may not be suitable if they're vegetarian, or it is against their faith or culture.
- Use a petroleum-based jelly, such as Vaseline®, to help moisturise their lips. Do not use Vaseline if they have oxygen therapy because it can cause blistering and can be a fire hazard. Use a water-based jelly, such as KY-Jelly®, instead.
Sore mouth
These are things that may help if someone's mouth is sore.
Mouthwashes, painkillers and lifestyle changes that may help with sore mouth
Ask the person's doctor or pharmacist about mouthwashes and painkillers. These might include a spray to numb and soothe the area before they eat.
If they can, they should try to avoid alcohol and tobacco. Or see if they can reduce how much they drink or smoke.
Tips for eating and drinking with a sore mouth
- Let hot food cool down a bit before eating.
- Avoid dry foods like biscuits, toast and crisps. But if someone wants to have them, encourage them to chew them well and have them with - plenty of drink.
- Soothe the person's mouth with cold liquid foods like custard, yoghurt, ice cream, jelly, mousse or chilled soups.
- Try softer foods like porridge, pasta with a sauce, egg dishes, fish in sauce and milky puddings.
- Eat food that's moist or soft by using gravy or sauces.
- Avoid acidic food such as citrus foods.
- Avoid spicy foods like curries and pickles.
- Try drinking through a straw to stop liquids having contact with the sore part of their mouth.
Getting support when you're caring for someone
As someone becomes less well, they might need more support from you with things like their mouth care. This may bring about lots of different feelings for both of you.
You might find some of the things you're doing to support them physically and emotionally difficult. And the person who's ill may feel like they're losing their independence which could affect their confidence. People can also worry about a loss of dignity and privacy.
If you or the person you're caring for have concerns or do not feel comfortable, speak to their GP or district nurse. You could ask if a healthcare professional can be there to support you the first time you help someone with mouth care. If they're not able to be there in person, they might be able to give you support over the phone.
You can also ask the GP or district nurse to talk you through options including how to get help with personal care for the person you're supporting.
Getting support from Marie Curie
If you would like to speak to someone about how you're feeling or for practical information about caring for someone, contact the free Marie Curie Support Line on 0800 090 2309*. Or you can email us at support@mariecurie.org.uk.
If you feel it would be helpful to speak to one of our Information and Support Nurses, please let the Support Line know and they can arrange a call back for you.
You may also find you want to get in touch with other people who are affected by terminal illness through our online community. It can be a space to chat, share experiences and support with others who may dealing with some of the same things that you are.
Watch: Brian's storyWatch: Brian's story
Brian talks about his experience of caring for his wife, including how they overcame his wife's problems with eating.