Registered Nurses' Association of Ontario

Oral Hygiene Products Appropriate for those at Risk of Aspiration







Soft bristled toothbrushes are preferred to avoid

injuring the teeth and gingiva (gums)


Small headed toothbrushes (pediatric) may be

more effective at reaching difficult areas (the

shape and size of the toothbrush should be

chosen to suit the patient’s mouth for optimal

delivery of oral care)

Toothbrushes should be replaced at least every three months


Place toothbrushes upright and allow to air-dry


All oral tissues should be brushed not just teeth. Those with dentures

need to brush oral tissues with a soft brush.



Oscillating, rotating powered toothbrushes can be

more effective in removing plaque than traditional

manual toothbrushes




Clinical reports suggest the use of suction

toothbrushes in individuals diagnosed with

dysphagia or those who are intubated


Oral Rinses


Alcohol-based oral rinses should be avoided for

patients who experience dry-mouth


Compounded oral rinses should be avoided


Oral rinses should contain fluoride for dentate


Fluoride is a chemical agent which

remineralizes and protects teeth

from demineralization


Products containing fluoride

(toothpastes and oral rinses) are

only necessary for dentate patients



Chlorhexidine rinse or gel is an antimicrobial agent

Consult with pharmacist, dental

team and/or physician before using this product. A prescription

is required


Long-term use of chlorhexidine

oral rinses can result in taste

alterations and brown staining of

oral hard tissues and dentures


Fluoride products should be used a

minimum of two hours apart


Preferred concentration of product

is 0.12% (without alcohol for

individuals with dry mouth)

Foam swabs


Foam swabs may be used to topically apply other products for patients who experience sensitive mucosa


May be used to remove surface debris, but is ineffective for plaque removal; toothbrushes are more effective in plaque removal and gingival stimulation,

even when combined with water alone

Using a toothbrush to remove

debris is more effective


Use with caution in those

exhibiting reactive behaviours

who are at risk of biting and

swallowing/choking on swab


Lemon glycerin

DO NOT use lemon and glycerin swabs

Lemon and glycerine swabs

cause softening and erosion

of the tooth enamel

Saliva substitutes


Can facilitate chewing, swallowing, speaking and lessen night time awakenings due to dry mouth


Medicated gum with chlorhexidine acetate/xylitol shown to reduce denture stomatitis and chelitis




Water-based products are recommended over

petroleum products (e.g. vaseline)

Water-based products hydrate the

dry tissues while petroleum

products primarily serve to prevent

further moisture loss


If safe, sips of water can be the

best hydrator

Tongue cleaners


The tongue should be brushed or cleaned to reduce bad breath


Tongue scrapers or cleaners are more effective in reducing bad breath than brushing alone




The choice of toothpaste should depend on the

individual needs of the patient/client

Non-foaming pastes should be

used for individuals diagnosed

with dysphagia or for those who

cannot tolerate foam


Fluoridated pastes for dentate

individuals. Fluoridated pastes are

not required for those who are



Use a toothpaste for sensitive

teeth if required

Interproximal cleaning


Flossing will clean unexposed surfaces of the teeth that are not accessible by tooth brushing alone


Examples of this product include traditional string floss, floss wands, interdental stimulators, and


Patients should be reminded to

floss regularly



An antifungal agent commonly prescribed to treat

candidal infections

Consult with pharmacist, dental

team and/or physician before

using this product



Single agent products should be used


Pain resulting from oral complications should be

treated systemically when local measures are


Compounded analgesic oral rinses

should be avoided as these can

delay healing of conditions such

as oral mucositis

Clinical Management
Oral Health: Nursing Assessment and Intervention
Point of Care Resources