oral care

1. Oral hygiene or Mouth care

2. Definition
 Oral hygiene is the practice of keeping the mouth
clean and healthy by brushing, flossing and using
appropriate therapeutic aids to prevent caries (tooth
decay) and periodontal disease.

3. Risk factors for Oral problems
 Patient who are paralysed or seriously ill
 Unconscious patient
 Diabetic patients
 Patients undergoing radiation therapy
 Patients receiving chemotherapy
 Patients having oral surgery, trauma etc.
 Patients with immunosuppressant drugs eg: HIV
patients

4. Effects of Neglected Mouth
 Gingivitis – inflammation of the gums
 Glossitis – inflammation of the tongue
 Stomatitis – inflammation of the mucous membrane
of mouth
 Periodonitis – inflammation of the tissues
surrounding the teeth
 Root abscess – pus formation in the root of the teeth
 Halitosis – bad breath
 Dental caries – decaying of teeth

5.  Pyorrhoea – pus formation in the sockets of
teeth
 Cheilosis – cracking of lips
 Anorexia – loss of appetite
 Parotitis – inflammation of the parotid
glands
 Sinusitis – inflammation of the sinus cavity
 Otitis media – inflammation of the middle
ear

6.  Tonsilitis – inflammation of the tonsils
 Adenitis – inflammation of the lymph gland and
adenoids
 Gastritis – inflammation of the stomach lining

7. Purpose
 To maintain healthy state of mouth, teeth, gums and
lips
 To clean the teeth of food particles, plaque and
bacteria
 To stimulate appetite
 To provide a sense of well-being
 To massage the gums
 To relieve discomfort resulting from unpleasant
odours and tastes
 To prevent gum inflammation and infections

8. General guidelines
 Oral hygiene should be performed before breakfast,
after meal and at bedtime
 Oral hygiene is important for patients receiving
oxygen therapy, patients who have nasogastric tubes
and patients who are NPO.
 Provide privacy to patient
 Oral care for the unconscious patient should be
performed at least every 4 hourly
 Vaseline may be applied to the lips to keep them
from drying out.

9.  Nursing observations for the patient’s mouth should
be recorded in the clinical record, noting such factors
as:
a) Bleeding
b) Swelling of gums
c) Unusual mouth odor
d) Effect of brushing the teeth

10. Various oral care agents for oral hygiene
 Tooth paste
 Nystatin
 Chlorhexidine gluconate
 Sodium bicarbonate
 Fluconazole
 Sucralfate
 Fluoride

11. Another solutions are:
 Potassium permagnate (1:5000)
 Sodium chloride ( 1 teaspoon to a pint of water)
 Potassium chloride (4 to 6%)
 Hydrogen peroxide (1:8 solution)

12. Mouth care of conscious patient
 ARTICLES
A tray containing
1. A small mackintosh
2. Face towel
3. Feeding cup
4. Dentifrice
5. Gauze piece
6. Kidney tray
7. Paper bag
8. Cleaning agent
9. Emollient

14. Nursing action Rationales
 Identify the client and
check for any special
orders
 Explain the procedure
to the patient
 Collect all articles
 Provide information fosters
cooperation,
understanding and
participation in care.
 Organization facilitates
accurate skill performance

15.  Provide privacy
 Perform hand hygiene
 Prepare solution for
mouth care
 Assist the client to
provide comfortable
upright position or
sitting position.
 To prevent the spread of
infections
 Solutions must be
prepared each time
before use to maximize
their efficacy
 To promote his/her
comfort and safety and
effectiveness of the care
including oral inspection
and assessment

16.  Inspect oral cavity
a) Inspect teeth, gums,
mucosa and tongue, with
the aid of gauze-padded
tongue depressor and
torch
b) Find out if any
abnormalities eg:
bleeding, swollen gums,
ulcers, sores etc
 Comprehensive assessment
is essential to determine
individual needs
 Some clients with anemia,
immuno suppression,
diabetes, renal impairment,
epilepsy, and taking
steroids should be paid
attention to oral condition.

17.  Place face towel over the
clients chest or on the
thigh with mackintosh
 Put kidney tray in hand
or assist the client in
holding a kidney tray.
 To prevent the clothing
from wetting and not to
give uncomfortable
condition
 To receive disposal

18.  Help the client to rinse his
mouth. Instruct the client to
brush teeth. Points of
instruction:
a) Client places a soft
toothbrush at a 45° angle to
the teeth.
b) Client brushes in direction
of the tips of the bristles
under the gum line with
tooth paste. Rotate the
bristles using vibrating or
jiggling motion until all
outer and inner surfaces of
the teeth and gums are clean
 To moisten the mucous
membrane
 Effective in dislodging debris
and dental plaque from teeth
and gingival margin

19. c) Client brushes biting
surfaces of the teeth
d) Client clean tongue
from inner to outer and
avoid posterior
direction
 If the client cannot
tolerate toothbrush,
then swabs or cotton
balls can be used
 Cleansing posterior
direction of the tongue
may cause the gag reflex
 When the client is prone
to bleeding and/or pain,
tooth brush is not
advisable

20.  Rinse oral cavity:
a) Ask the client to rinse
with fresh water and
void contents into the
kidney tray.
b) Advise him/her not to
swallow water.
 Ask the client to wipe
mouth and around it
 To provide comfort and
not to retain any fluid
and debris
 To reduce potential for
infection
 To provide comfort and
provide the well-
appearence

21.  Confirm the condition of
client’s teeth, gums and
tongue. Apply lubricants
to lips. Make the client
comfortable.
 Rinse and dry tooth
brush thoroughly. Return
to the proper place or
personal belongings after
drying up.
 To moisturize lips and
reduce risk for cracking
 To prevent the growth of
microorganisms

22.  Replace all articles.
 Discard dirty swabs
properly and safely. Clean
all the articles
 Wash your hands
 Document the care and
sign on the records
 Report any abnormal
findings if present
 To prepare equipment for
the next procedure
 To maintain standard
precautions
 To prevent the spread of
infection.
 Documentation provides
ongoing data collection and
coordination of care
 To provide continuity of
care

23. ORAL CARE FOR
UNCONSCIOUS
CLIENTS

25. Suggested Action Rationale
Assessment:
 Check the client's identification
and condition and NCP. Assess
oral cavity.
 Test the gag reflex by placing
tongue blade on posterior part of
tongue
 Explain to the relatives about the
purpose and the procedure.
Planning:
 •Consult with the client relatives to
determine a convenient time
 •Assemble supplies:
 To assess sufficient condition on
the client
 Reveals whether the patient is at
risk of aspiration
 Providing information
 Promote cooperation
 Demonstrates organization and
efficient time mgt

26. Planning:
•Equipments required:
A tray containing –
•Tongue depressor (1): to
suppress tongue
•Artery forceps (1)
•Mouth gag (1)
•Dissecting Forceps/thumb
forceps (1)
•Torch(1)
•A Bowl with Oral care agents:
Antiseptic solution/NS
• Cotton ball
•Kidney tray (1)
•Mackintosh (1): small size
•Face towel (1)
•feeding cup with water
•Paper bag
•Square gauze piece (size 2” X
2”)
•Lubricants: Vaseline/ Glycerin/
/ lip cream (1)
•Disposable gloves( 1 pair): if
available

27. •Perform hand hygiene and
wear gloves
•Put all required equipments to
the bed-side and set up.
•Close all windows and doors,
and put the screen or / and
utilize the curtain if there is.
•Placing the appropriate
position:
1) Move the client near towards
you.
2) Position the patient on side,
head turned towards you
• To prevent spread of infection
• Appropriate setting can make
the time of the procedure
minimum and effective.
• To ensure that the room is
warm. To maintain the
privacy.
• To make him/her more
comfortable and provide

28. •Separate the upper and lower
teeth with padded tongue
depressor or apply the mouth
gag
•Place the mackintosh and towel
on the neck to chest.
•Put the kidney tray over the
towel and mackintosh under
the chin
•Soak the cotton ball in
antiseptic solution with artery
forceps.
•Squeeze all cotton balls excess
solution by artery forceps and
dissecting forceps
• Provide access to oral cavity
• Protect the client and bed from
soakage
• Facilitates drainage from the
client’s mouth
• Cleaning solutions aids in
removing residue on the
client’s teeth and softening
encrusted areas.
• To avoid inspiration of the
solution

30.  Implementation:
•Clean the client’s teeth from
incisors to molars using up
and down movements from
gums to crown.
•Clean oral cavity from
proximal to distal, outer to
inner parts, using cotton
ball for each stroke.
•Discard used cotton ball into
small kidney tray.
•Clean tongue from inner to
outer aspect.
• Friction cleanses the teeth
• To prevent the spread of
infection
• Microorganisms collect and
grow on tongue surface and
contribute to bad breath.

31. Implementation:
•Rinse oral cavity:
1) Provide tap water to gargle
mouth and position kidney
tray.
2) If the client cannot gargle by
him/herself,
a) rinse the areas using moistened
cotton balls or
b) insert of rubber tip of irrigating
syringe into the client’s mouth
and rinse gently with a small
amount of water.
3) Assist to void the contents into
kidney tray. If the client cannot
spit up, especially in the case of
unconscious client, suction any
solution.
• To remove debris and make
refresh
• Rinsing or suctioning removes
cleaning solution and debris.
• Solution that is forcefully irrigated
may cause aspiration
• To avoid aspiration of the solution

32. Implementation:
•Confirm the condition of
client’s teeth, gums, mucosa
and tongue.
•Wipe mouth and around it.
Apply lubricant to lips by
using foam swab or gauze
piece with artery forceps
•Reposition the client in
comfortable position.
•Replace all equipments in
proper place.
•Discard dirt properly and safety
• Remove gloves and perform
hand hygiene
• To assess the efficacy of oral
care and determine any
abnormalities
• Lubricant prevents lips from
drying and cracking.
• To provides for the client’s
comfort and safety.
• To maintain standard
precautions

33. Evaluation:
•Client experiences, inspect
oral cavity and surrounding
skin surfaces.
Document:
• Document on the chart with
your signature and report
any findings to senior staff.
o Date & time
o Type and extent of
hygiene
o Client response
o Assessment findings
observed during oral care.
• Helps to assess the hygiene
and effectiveness of care
• Identify any injury
• Documentation provides
coordination of care.
• Giving signature maintains
professional accountability

34. Care of Dentures

35. Care of Dentures
• Encourage patients to clean their dentures on a
regular basis to avoid gingival infection and
irritation.
• Dentures are the patient’s personal property and
must be handled with care because they break easily.
• They must be removed at night to rest the gums and
prevent bacterial buildup.
• To prevent warping, keep dentures covered in water
when they are not worn, and always store them in an
enclosed, labeled cup with the cup placed on the
patient’s bedside stand.

36. Care of Dentures
• Discourage patients from removing their dentures
and placing them on a napkin or tissue because they
could easily be thrown away.
• The skill of denture care can be delegated to nursing
assistive personnel (NAP).
Instruct the NAP to:
 Inform the nurse of any cracks in dentures.
 Inform the nurse if the patient complains of oral
discomfort.
 Inform the nurse of any lesions in the mouth

37. Care of Dentures
• Equipment needed includes a soft-bristle toothbrush
or denture toothbrush, a denture- cleaning agent or
toothpaste, a glass of water, an emesis basin or sink,
a washcloth, clean gloves, and a denture cup (if
dentures are to be stored after cleaning)
• Do the brushing as like before and store in closed
container in water