ORAL HYGIENE Care of Independent , Dependent & Unconscious Patients , Care of Dentures
UPDATED 2024
Oral hygiene means maintaining the cleanliness of the mouth. Oral hygiene includes measures to prevent the spread of disease from the mouth and increase the comfort of the patient
It is important because mouth is the portal entry of food and digestion starts from mouth. So, the entry of any pathogen in mouth directly affects health.
Oral hygiene means the cleanliness of the mouth oral hygiene includes measure to prevent the spread of disease from the mouth and increase the comfort
Objectives
- To keep the mouth and teeth in good condition
- To prevent the mucous membrane from becoming dry and cracked
- To prevent sores which resulting in ulceration
- To prevent bacterial in the mouth from causing local and general infections
- Emollients help to soften the dry mucus membrane to prevent cracking
Purpose
- To prevent and treat mouth infections
- To keep the mouth fresh and clean
- To prevent the mucus membrane from becoming dry and cracked
- To prevent dental caries and tooth decay
- To prevent sores which resulting in ulceration
- To stimulate salivation and increase appetite
- To prevent infection of parotid glands
- To prevent complications such as stomatitis, glossitis, pyorrhea and parotitis, etc
- To stimulate circulation in gums thus maintaining health firmness
- To maintain oral hygiene among bedridden patients
The Patient who may require Frequent Mouth Care
- Unconscious patients
- Helpless patient
- Patient with higher pyrexia
- Malnourished and dehydrated patients
- Patients who are not taking oral feeds
- Patients have local diseases of mouth
- Paraplegic patients
- Patients having a local disease of mouth
- Postoperative patients
Scientific Principles
- Any new treatment or exposure to unfamiliar situation produces fear and anxiety
- Food particles left in the mouth promote the growth of microorganism
- Soap which is constituent of most dentrifrice has a low surface tension and spreads readily and penetrate in between teeth
- Cold water reduces friction and hot water destroys dentures
- Cough reflex is depressed in unconscious patients
- Giving mouth care provides opportunity to observe the condition of mouth and teeth
- Knowledge about the technique of keeping the mouth healthy helps in practicing it and maintains
- A clean mouth and teeth aids to the patient a feeling of self-approval
- Emollient help to soften the dry mucous membrane to prevent cracking
- Patients comfort and safety may be enhanced by practice of good techniques, which provide economy of time, material and energy
Solutions Commonly Used for Mouth Wash
- Potassium permanganate (KMnO4) 1:5000 (crystal to a glass of water)
- Sodium chloride – one teaspoon to a pint of water
- Potassium chloride – 4-6%
- Hydrogen peroxide (H2O2) 1:8 solution
Dentifrices Used
- Glycerin with lime juice equal parts
- Sodium bicarbonate paste
- Reliable tooth paste or powder
Emollient Used Commonly
- Clean or butter
- White Vaseline
- Liquid paraffin
- Glycerin borax
- Olive oil
Preliminary Assessment of the Patient and Environment
- Identify the patient and observe the general condition of the patient
- Check the condition of the mouth
- Assess the ability of the patient to cooperate
- Prepare the patient for acceptance and realization
- Assess the status of health habits
- Decide the type of dentifrice and emollient to be used
- Assess the frequency of mouth care needed
- Note the precautions to be observed while moving the patient
- Articles available in the unit
- Make sure about any or drink to be given after mouth care if advisable
Equipment
A tray containing of:
- Mackintosh and towel
- Small jug with warm water
- Feeding cup
- Small cups – 2
- Artery forceps – 1
- Dissecting forceps – 1
A small container containing of:
- Paper bag
- Kidney tray
- Choose one of the solutions for mouthwash
- Choose one of the emollients
- Gauze piece
- Face towel – 1
Procedure
- Bring patient to edge of bed
- Position pillow according to comfort of patient
- Place small mackintosh with face towel on patient’s chest
- Place K-basin close to chin of patient
- Raise head end of the bed to 45 degree
- Pour antiseptic solution into cup
- Soak gauze piece in solution and squeeze out excess solution by using artery clump
- Use same clamp to clean patient’s mouth (avoid mixing of clamps)
- Clean using up and down movements from gums to crown, clean oral cavity from proximal to distal, outer to inner aspect
- Discard used cotton balls into K-basin
- Provide tumbler of water and instruct the patient to gargle mouth. Position K-basin so that spillage is avoided
- Clean tongue from inner to outer aspect
- Provide water to rinse mouth and dry face with towel
- Lubricate lips using swab stick
- Rinse the used articles and replace equipment
- Document time, solution used, condition of oral cavity, abnormalities noticed and patient’s response
Complication of Neglected Mouth Care
Local Complications
- Parotitis: inflammation of the parotid glands
- Stomatisis: inflammation of the mucus membrane of the mouth
- Gingivitis: inflammation of the gums
- Glossitis: inflammation of the tongue
- Dental caries: forms cavity in the teeth
- Root abscesses: pus formation in the root of the teeth
- Periodontal diseases: it is also known as pyorrhea or pus formation in the sockets of teeth
- Bleeding gums: deficiency of vitamin C and use a hard brushing of the teeth
Complication Neighboring Structure
- Parotitis: inflammation of the parotid gland
- Rhinitis: inflammation of sinus cavity
- Otitis media: inflammation of middle ear
- Tonsillitis: inflammation of the tonsils
- Adenitis: inflammation of the adenoids
Systemic Complication
- Anorexia: loss of appetite
- Bacterial endocarditis: inflammation of the endocardium
- Gastritis: inflammation of the stomach
- Nephritis: inflammation of the kidneys
- Rheumatic arthritis: inflammation of the joints
Recording and Reporting
- Record the procedure with date, time and condition of the mouth, teeth, etc, on nurse’s record
- Report and record any abnormal condition to the ward sister and physician
- Give health education to the patient and relatives on oral hygiene
ORAL HYGIENE FOR INDEPENDENT PATIENTS
Patients who are able to sit in a Fowler’s or semi-Fowler’s position can usually perform their own oral hygiene as long as the necessary supplies are within easy reach. For independent patients, sitting on the edge of the bed or standing at the sink is also an option when performing oral hygiene.
While a patient is performing oral hygiene, it is important for you to observe the process and provide any necessary teaching about brushing and flossing. This is also a good time to discuss the importance of oral hygiene and good oral health with the patient
When patients become ill, have surgery, or have a medical condition that inhibits the use of their hands, you must perform oral hygiene for them. Before assuming dependent patients are incapable of performing any of their oral hygiene, be sure to assess their level of dependence and invite them to participate in any way they can.
Be sure to add the level of assistance that is required to the patient’s plan of care. The healthcare team can then be aware of how and to what extent they have to assist the patient with oral care
ORAL HYGIENE FOR DEPENDENT PATIENTS
Patients become ill, have surgery, or have a medical condition that inhibits the use of their hands; you must perform oral hygiene for them. Before assuming dependent patients are incapable of performing any of their oral hygiene, be sure to assess their level of dependence and invite them to participate in any way they can be sure to add the level of assistance that is required to the patient’s plan of care. The healthcare team can then to aware of how and to what extent they have to assist the patient with oral care
ORAL HYGIENE FOR UNCONSCIOUS PATIENTS
Proper positioning can help reduce the risk of aspiration. For an unconscious patient, the best position is side-lying with the patient’s head turned toward you in either a semi-Fowler’s position or with the head of the bed flat. Placing the patient is one of these positions allows fluid and any oral secretions to collect in the dependent side of the mouth and drain out
Use a soft-bristled toothbrush and toothpaste to brush your patient’s teeth gently to remove any debris, and then brush the patient’s tongue. Use a syringe and water to rinse the teeth and tongue. Then use foam swabs moistened with diluted hydrogen peroxide or other facility-approved solution to remove crusts and secretions from the mucous membranes of the mouth. Be sure to suction any oral secretions that pool in the patient’s mouth during the procedure
Since, an unconscious patient cannot report any mouth pain or discomfort, perform a thorough assessment of the oral cavity each time you provide oral hygiene. If you note any inflammation, infection, sores, or bleeding, initiate treatment immediately since oral health can affect the patient’s overall health status
CARE OF DENTURES
Care of dentures of artificial teeth is the responsibility of the nurse to guard against offending patient, by helping them to take care of their mouth
Equipment Needed
- Soft bristled tooth brush
- Denture tooth brush
- Dentifrice
- Warm and cold water in glasses
- Gauze pieces
- Wash cloth
- Plastic denture cup
- Gloves
- Basin
Care of Dentures
Procedure
- Explain and secure the cooperation of the patient
- Remove the denture and inspect the oral cavity for abnormalities if any
- Wash hands and keep the articles near the bed side sink
- Take a basin and fill half of it with water
- Put on gloves to reduce transmission of infection
- Ask the patient to remove dentures and place them in the basin
- Brush the dentures. Use back and front motion. Clean inside and outside by brushing
- Rinse dentures thoroughly in running water
- Return them to the patient to keep them in a denture cup in cold water
- With a soft bristled tooth brush the gum with tooth paste as well as the palate of tongue also
- Rinse the mouth thoroughly with cold water
- Wipe the face and make the patient comfortable
Procedure
Precautions
- In cleaning dentures, they should be held firmly as water reduces friction between the teeth and finger. They are liable to slip and fall down
- Denture should be dipped in cold water to prevent friction
- Hot water may destroy dentures, dentures are expensive and may be difficult to replace if broken or lost
- Privacy should be maintained
- Discourage the use of brushed with hard bristles because they cause grooves in dentures
- If the patient is capable of self-care, arrange the articles within the easy reach of the patient
- Encourage the patients to wear the denture during the day. This will improve the eating technique, speck appearance and contour of the mouth
- Seriously ill patient or a patient who is under anesthesia or an unconscious patient, the denture is removed for fear of dislodging the denture and blocking the respiratory passage
- When dentures are removed from the patient mouth, they should be stored in a labeled container to prevent lost and breakage
