Unconscious Residents

Special care must be provided to any resident who is not conscious, particularly because unconsciousness or impaired consciousness places the resident at a risk for aspiration and subsequent health problems including aspiration pneumonia. This is a likely situation among nursing home residents or patients that are terminally ill, those medicated for advanced illness, or others with severe brain damage caused by strokes, cancer, or other conditions.²⁵

A state of unconsciousness places a patient in total dependence on their caregivers, including for their oral care. This state also increases the likelihood of mouth-breathing, which leads to xerostomia. This can lead to higher rates of caries and infections, including fungal infections such as candidiasis (also known as thrush), most often caused by the pathogenic yeast Candida albicans. Aspiration is one of the greatest risks posed by unconsciousness, as any saliva, oral medication, or water or products used to cleanse or moisten the mouth can be aspirated into the lungs.

As with all patients, the plan of care should be followed when providing mouth care to unconscious patients. The caregiver will need to carefully turn the patient to their side so that any liquid can drain out of the mouth instead of risking aspiration. For the same, reason, any water or products used to cleanse the mouth or provide comfort should be used minimally to avoid liquid pooling in the mouth or running back to the airway. Because these patients are likely to have dry mouth, frequent moistening is necessary with these precautions, as well as the use of a water-based lip balm.

Important Reminders for Caregivers:

• Provide oral care every two hours for residents who are unconscious or unresponsive.²⁶

• Turn resident to side to prevent fluid from going into airway (this can cause a serious lung infection called aspiration pneumonia).

• Use lightly moistened mouth swabs to clean inside of mouth (do not use lemon swabs since they are acidic).

• Utilize a moist soft toothbrush without toothpaste to clean all tooth surfaces.

• Keep lips moist with water-based lubricant each time oral care is given.

• Do not use toothpaste or try to rinse, which may cause choking.

• Look inside mouth and report any red or white areas on gums or tongue.