Many of the people you support cannot easily tell you when something is wrong with their mouth. They may be living with dementia, have a learning disability, have communication difficulties, or simply not realise that what they're experiencing isn't normal. That's why your eyes matter.
You don't need to be a dentist to notice that something isn't right — a mouth that looks red and sore, dentures that no longer seem to fit, someone who has stopped eating foods they used to enjoy. These are things you can see, and seeing them early makes a real difference. Most serious mouth problems start as something small that gets missed: an ulcer that doesn't heal, gums that bleed every time teeth are brushed, white patches that weren't there before. By the time someone is in significant pain, the problem has often been developing for weeks or months.
Spotting problems early protects more than comfort. In dependent adults, poor oral health is linked to chest infections and aspiration pneumonia, because bacteria from the mouth can be breathed into the lungs — a risk that's higher for people who have difficulty swallowing or spend long periods lying down. Improving daily mouth care and catching problems early genuinely reduces this risk.¹
Your role is not to diagnose. It's to notice and refer. It's better to refer something that turns out to be nothing than to miss something that matters. Looking takes seconds, and building a quick glance into the care you already provide fits naturally with the Making Every Contact Count approach.²
How to look safely
Looking in someone's mouth doesn't have to be complicated or uncomfortable. The "lift the lip" approach, from the Mini Mouth Care Matters programme, works across all ages and settings.³ You need good lighting (natural light or a torch), clean gloves, and a few minutes during routine care.
1. Explain what you're doing — even if the person has limited understanding, talking it through helps them feel comfortable. "I'm just going to have a quick look at your mouth to check everything's okay."
2. Position yourself to see clearly — stand or kneel in front of someone sitting; adjust the bed height and lighting for someone in bed.
3. Gently lift the lip — with a gloved finger, lift the top lip to see the front teeth and gums, then the bottom lip. Look for redness, swelling or anything obvious.
4. Ask them to open their mouth — if they can cooperate, so you can see the tongue, cheeks and roof of the mouth. A small torch helps.
5. Check dentures separately — help remove them and check both the dentures and the mouth underneath.
Build checks into your routine — morning personal care, helping with brushing, around meals, helping with dentures, or any time the person mentions discomfort. A brief visual check during daily care is ideal; more thorough checks might happen weekly or whenever you notice a change.
What to use. A soft, small-headed toothbrush for cleaning, and a torch and gloves for looking. Foam swabs (the small pink sponges on sticks) are not recommended — the foam head can detach and cause choking, and a national safety alert followed a death where this happened. They're also poor at removing plaque. If someone can't tolerate a toothbrush, a damp piece of gauze can clean gently, but a soft toothbrush remains the most effective tool.⁴
What to look for
Here are the most common problems you might see — what each looks like, what it might mean, and what to do.
Red or swollen gums. Gums that look red rather than pink, swelling along the gum line, or bleeding when teeth are brushed. This is usually gum disease, caused by plaque building up when brushing isn't thorough or frequent enough. What to do: improve daily brushing, cleaning along the gum line — and don't stop brushing because the gums bleed; gentle, consistent brushing is the treatment. If bleeding or significant swelling continues despite good brushing over about two weeks, arrange a dental review.⁵
White patches (thrush). White or cream patches on the tongue, cheeks, roof of the mouth or gums, sometimes like cottage cheese, which can wipe off to leave red, sore areas. This is usually oral thrush, a fungal infection common in people who wear dentures, use steroid inhalers, have a dry mouth, take antibiotics or have a weakened immune system.⁶ What to do: arrange a dental or medical review, as thrush usually needs antifungal treatment. Keep up good mouth and denture care, and if the person uses a steroid inhaler, make sure they rinse their mouth after each use.
Mouth ulcers and sores. Small round or oval sores with a white, yellow or grey centre and a red border. Most are minor and heal within one to two weeks. What to do: keep the mouth clean and avoid spicy or acidic foods while it heals. But an ulcer that hasn't healed after three weeks needs to be seen — a non-healing ulcer is one of the signs a dentist or doctor checks for mouth cancer, so it should never be ignored, even without pain.⁷
Dry mouth. Cracked or peeling lips, a dry or cracked tongue, thick or stringy saliva, difficulty swallowing or speaking. Very common in older people, most often caused by medication (particularly antidepressants and antihistamines), and also by dehydration, anxiety, diabetes or radiotherapy.⁸ What to do: encourage regular sips of water; saliva substitutes are available from pharmacies; and a medication review with the GP is worthwhile. Keep up good mouth care, as a dry mouth significantly increases the risk of decay and infection.
Broken or decayed teeth. Visible chips, cracks or missing pieces; dark brown or black areas (usually decay); teeth that look worn, loose or have moved. What to do: arrange a dental review, as these can cause pain and infection if left. Keep up good mouth care, make sure pain relief is available, and check the person is still eating and drinking enough. A sharp broken edge cutting the tongue or cheek should be seen promptly.
Ill-fitting dentures. Dentures that move when talking or eating, gaps against the gums, red sore areas, or someone reluctant to wear them. Dentures loosen over time as the mouth changes shape, and some people simply stop wearing them rather than complain. What to do: arrange a dental review for adjustment or replacement, check they're being cleaned properly and removed overnight, and give sore areas a rest from the denture where possible. Persistent redness under an upper denture can signal denture-related thrush.⁶
Bad breath. A persistent unpleasant odour even after brushing. Usually points to bacteria from poor oral hygiene, gum disease or trapped food, and can also come from dry mouth, infection or ill-fitting dentures. What to do: improve mouth care — brushing teeth, gums and tongue twice daily and cleaning dentures properly. If it persists, arrange a dental review to check for an underlying cause.
Signs of pain or difficulty eating. Avoiding certain foods, eating slowly, leaving meals, rubbing the face or jaw, reluctance to open the mouth, or changes in behaviour or mood. People living with dementia or communication difficulties may not be able to tell you directly, so behaviour is an important clue. What to do: arrange a dental review, offer softer foods, make sure pain relief is available, and write down what you've noticed. Behavioural change in someone who can't report pain should be taken seriously, not assumed to be unrelated.
Adapting your approach
A one-size-fits-all approach rarely works. These principles sit alongside the standards for mouth care in care settings.⁹
- For people living with dementia — move slowly and calmly, keep eye contact and a gentle tone, and try different times of day if there's resistance. Familiar songs or gentle distraction can help. Don't force it; do what you can and try again later.¹⁰
- For people with a learning disability — use simple, clear explanations, allow extra time, and lean on visual schedules or social stories if the person responds well to them. A familiar, predictable routine is often reassuring.
- For people who resist care — resistance usually has a reason: anxiety, pain, or difficult past experiences. Try a different approach, time or person. "Good enough, often enough" is a realistic goal, and partial care is far better than none. If resistance is new or sudden, treat it as a possible sign of pain and raise it with a senior colleague.
What to record
When you notice something, write it down — good records help the dental team and provide evidence for care planning and inspection.⁹ Record what you saw (as clearly as possible), where in the mouth, when you first noticed it, any changes since the last check, any related symptoms such as pain or eating difficulties, and what action you took.
When to get help
Not every observation needs urgent action. Use these bands to decide what to do and how quickly.
- Routine dental review — for non-urgent problems: gums that bleed with brushing, minor chips with no pain, gradual plaque or tartar build-up, a check-up that's due, or dentures becoming loose.
- Prompt review (within about two weeks) — for problems that shouldn't wait: bleeding gums that persist despite good brushing, bad breath that doesn't improve, possible thrush, a broken tooth without severe pain, non-healing sore areas under dentures, or dry mouth affecting comfort.
- Prompt dental or GP appointment so they can refer on — a small number of signs need a clinician to assess and, if needed, make an urgent referral (the signs checked when ruling out mouth cancer, never to be ignored even without pain): an ulcer that hasn't healed after three weeks, a tooth that's become loose for no clear reason, a red patch (or mixed red-and-white patch) that doesn't clear, or an unexplained lump in the mouth or neck. National guidance asks the dentist or GP to arrange specialist assessment within two weeks.⁷
- Urgent, same-day care — for facial swelling, a suspected abscess, bleeding that won't stop, severe pain despite pain relief, or spreading infection with fever. NHS 111 can advise and direct you to urgent dental care. With facial swelling and fever, or any difficulty breathing or swallowing, treat it as a medical emergency and seek immediate help.
For people in care settings, ask your manager about established dental links — many areas have Community Dental Services that visit or offer priority access. If you're ever unsure whether something needs urgent attention, seek advice rather than wait. You're not expected to diagnose: your role is to notice, record and refer.
