ORAL HYGIENE – Nurse Info ORAL HYGIENE

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