Oral hygiene is an important, but often overlooked, aspect of care for older adults. Lack of oral care causes damage to dentition as well as other parts of the body. One area of concern is the respiratory system, with aspiration pneumonia being an issue for patients with poor oral care. Aspiration pneumonia occurs when contents of the oral cavity (including food debris, saliva, biofilm, or a combination of these) enter the bronchial tree and lung alveoli, causing an inflammation of the lungs, known as pneumonia (Pusins et al., 2018). Some causes of aspiration pneumonia include poor oral hygiene, side effects of certain medications, and dysphagia (which is defined as a difficulty in moving food from the mouth to the stomach). One third of patients with dysphagia will develop aspiration pneumonia, and approximately 60,000 individuals die from this complication yearly. The number of decayed teeth, any oral diseases that are present (which can increase bacteria levels in saliva), the frequency of teeth brushing, and dependency on a caregiver for oral care all increase the risk of developing aspiration pneumonia (Pusins et al.).

Decreased saliva causes dry mouth and impaired cleaning of the oral cavity that leads to reduced regeneration of the oral mucous membrane. A sticky paste that adheres in the mouth can form and become a prime area for bacteria to live. Dry mouth (xerostomia) can be caused by medications, aging, cancer therapy, nerve damage, health conditions (e.g., diabetes, stroke, thrush, or autoimmune diseases), mouth breathing, and tobacco, alcohol and recreational drug use. Hundreds of medications cause xerostomia, but the most notable are those used to treat depression, high blood pressure, anxiety, and pain, as well as antihistamines, decongestants, and muscle relaxants (Mayo Clinic, 2018).

Without oral care, dental caries and bacterial plaque can occur. Significant halitosis is a sign that decaying matter is present in the mouth. A visit to the dentist is necessary for patients with these issues. The inability to properly chew food, lack of awareness of food in the mouth, and inadequate swallowing of a food can lead to oral residue and increase risk of aspiration. In fact, 15% of individuals 65 years and older living in an independent living facility had swallowing difficulties (Pusins et al., 2018).

Moisturizing products, oral cleaning, and possibly evaluation by a speech-language pathologist and/or dentist are recommended. Assess medications and recommend changes to a similar drug that does not cause xerostomia, or to add a medication like pilocarpine or cevimeline that stimulates saliva production (Mayo Clinic, 2018). Gauze, sponge brushes, or special brushes for mucous membranes should be used to mechanically clean the tongue, teeth, and palate. A chemical mouthwash (specifically cetylpyridinium chloride and chlorhexidine gluconate) should be used along with mechanical cleaning (Aiemyen et al., 2020). It should be noted that the chemical mouthwash alone does not significantly decrease the risk of pneumonia, but patients do benefit with both mechanical and chemical cleaning methods.

Additional methods to help relieve dry mouth include sipping water, chewing sugar-free gums or sucking on sugar-free candies (if appropriate for patient), encouraging nasal breathing rather than mouth breathing, and adding a room humidifier (Mayo Clinic, 2018). Avoidance of caffeine, tobacco, alcohol, sugary and acidic foods (as they increase the risk of tooth decay), and staying away from over-the-counter antihistamines and decongestants if are recommended.

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