Mouth care is very important for the unconscious, disable, handicapped people. Is it important because if we don not take care of the mouth properly it will affect the normal living. So, read the slide and learn.

1. Topic
Mouth care

2. General objective
At the end of the session 45 minutes study of course the learner will be able to-
 Acquire knowledge and developed skills about mouth care.
Specific objectives:
At the end of the session the students will be able to-
 to describe the introduction about mouth care.
 to define mouth care accurately.
 to explain the principle of mouth care.
 to identify the purposes of mouth care.
 to list the indication of mouth care accurately.
 to list the complication due to neglected of mouth care.
 to health education for the patient to reduce dental diseases.
 to list the equipment of mouth care.
 to explain the procedure of mouth care perfectly.
 to describe the nursing care plan for the management of any complication developed by mouth care.

3. Introduction of mouth care:
The mouth is important for eating, drinking, speech,
communication, taste, breathing & the immune system.
Daily oral hygiene is critical oral diseases such as dental
decay, gingivitis & periodontitis but also because pathogens
responsible for pneumonias can be found in the oral cavity.
Inadequate oral care has also been associated with a
worsening of systemic health problems such as diabetes,
stroke, hypertension & MI. So it's important to keep the oral
mucosa & lips clean, soft, moist & intact. Oral hygiene is an
integral part of health care can prevent potential infections
as well as reduce distress & discomfort. Mouth care is also
known as “Oral hygiene”

4. Definition:
Oral Hygiene is the practice of keeping the mouth
Clean & healthy by Brushing & flossing to prevent tooth decay & gum disease
Or
Maintaining cleanliness of the oral cavity is known as the oral hygiene
Or
Oral hygiene is defined as “ the scientific care of the teeth & mouth’’
(Xavier 2000)

5. Aim of mouth care
1. Keep the oral mucosa & lips clean, soft, moist & intact.
2. Remove & prevent the build-up of food debris/ dental plaque
without damaging the gingiva.
3. Alleviate pain/ discomfort.
4. Prevent halitosis & freshen the mouth.
5. Maintain oral function
6. Decrease the risk of oral & systemic.
7. Increase general wellbeing.

6. Principles of mouth care
1. Intact mucous membrane serves as the final line of defense of
the body against diseases.
2. Pathogen grows well in a warm and moist environment. The
greater number of organisms, the greater is the possibility of
infection.
3. Pathogenic organisms may be transferred from the sources to
a new host by direct or indirect method.
4. The skin that is poorly nourished and dry has less ability to
protect and is more vulnerable to injury
5. H2O2 acts as anti infective

7. Cont.…
6. Hygienic practices vary between individuals, between
people of
Different economic status and different culture
7. Any unfamiliar situation produces anxiety.

8. Purposes of mouth care:1. To keep the oral mucosa & lips clean, soft, moist & intact
2. To alleviate pain
3. To remove& prevent the buildup of food debris ? Dental plaque
without damaging the gingiva
4. To keep the mouth clean and refreshed.
5. To increase general well being.

9. Cont.…
6. To prevent infection and dental caries
7. To prevent infection of salivary gland.
8. To treat a mouth infection.
9. To help maintain, improve patient's appetite.
10. To promote self esteem and comfort.

10. Cont.…..
11.To prevent complications such as stomatitis, glossitis,
pyorrhea, profits, halitosis etc.
12.To avoid foul breath and foul odor while talking.
13.To educate the patient and family regarding the
importance of oral hygiene.

11. Indications of mouth care:
1. Unconscious patient.
2. Helpless & serious patients
3. Patient with hyper-pyrexia.
4. Patient with NPO (nothing per oral).
5breathers.
6. Patient has local disease of the mouth
7. Patient on oxygen inhalation.
8. Patient on chemotherapy.
9. Malnourished & dehydration, patients

12. Cont.…
7. A patient who is unable to maintain adequate oral hygiene.
8. Patient with hyper-pyrexia.
9. Malnourished and dehydration patient

13. Contraindication of mouth care
 Oral surgery or trauma may contraindicated tooth
brushing

14. Complications
1.Gingivitis: Inflammation of gum.

15. Cont..
 Dental caries

16. Cont..
Stomatitis: Inflammation of the mucous membrane of mouth.

17. Cont..
 Pyorrhea ( Pus formation in the sockets of the teeth)

18. Cont..
 Parotitis ( Inflammation of the parotid gland)

19. Cont..
 Glossitis ( Inflammation of the tongue)

20. Cont..
 Cracked lips

21. Cont..
 Sores
 Anorexia ( Loss of appetite)

22. Health education for the patient to reduce dental
diseases:

23. Cont…
1.Moisten the tooth brush and apply tooth paste.
2.Hold the tooth brush at a 45 degree angel to the teeth.
3.Brush the front and back of all the teeth from the gum line toward.
4.Tongue should be cleaned every morning by a tongue cleanse.
5.Teeth should be cleaned twice daily(morning ,at night).
6.Consult with dentist every 2 month.

24. Advantages
Its help prevent oral cancer.
Its help prevent gum disease.
Its help detect dental problems early.
Its help maintain good oral health.
 save money
Pressure breath
Whiter teeth

25. Disadvantages
Mouthwash can be dangerous for children when
ingested.
Mouthwash can damage some parts of the
mouth, stain and darken teeth and also irritate
canker sores.

26. Solutions used for mouth care
 Normal saline solution : This is a solution of common salt with water, in proportion to
4gm in 500cc of water. This is commonly used in wards.
 Hydrogen peroxide (H2O2) : Solution is readily available in market as a deodorizing
agent, 5 – 20cc can be used for mouth purpose.
 Potassium permanganate: This is available in crystal form. 4cc of potassium
permanganate solution in a glass of water can be used for mouth care. Alternately 1 small
crystal can be put in a glass of water. This is a powerful disinfectant and deodorizing
agent.
 Soda-bi-Carb: The solution is made with 4gm of soda bi card powder in pint of water.
 Thymol solution: One-forth of half tea spoon of thymol is put in 1 cup of water ( 100-
150cc of water). It is acts as an antiseptic agent.
 Lemon juice: 2 tea spoons of lemon juice in a cup of water can be used as an
improvised methos for mouth wash.
NOTE: Never use Dettol as mouthwash antiseptic .

27. Precautions
Special precaution for providing oral care according to life span:
 Infant:
1. Use a dry gauze to remove accumulated secretions from an
infants gums.
2. Use a small, soft brush after first teeth have erupted.
 Child:
1. Remember that children younger than 30 years may not
understand what rinse or spit means. Don’t after them water to
rinse with if they are NPO because they will swallow the rinse.
2. Pay special attention to children to ensure removal of food
particles from the airway.

28. Cont..
 Older adult:
Because many older adults wear full or partial dentures be sure
dentures are removed & cleaned regularly. Special dentures cleansers
are available. Brush the gums or any remaining teeth well.
 Others:
1. Before offering mouth care must wash hands thoroughly (for
conscious patient).
2. Sit the patient fully upright position to prevent aspiration during
mouth care (for conscious patient).
3. Avoid oral care with H2O2 if oral thrush or oral lesson present.

29. Procedures of mouth care
Equipment's: A tray with cover-
 Feeding cup
 Mouth wash solution or
toothpaste and toothbrush
 Jug of water
 Kidney tray
 Galli pot with denture socking
solution
 Gauze piece with bowl
 1 artery forceps & 1 dressing
forceps
 Boroglycerine
 1 small towel & 1 small
mackintosh
 Tongue depressor
 Mouth gag
 Disposable gloves

30. Procedures
For conscious patients:
 Collect all equipment's
 Bring the tray to the bed side.
 Wash hands & don disposable gloves.
 Greet the patient & explain the procedure.
 Maintain Proper privacy.
 Help the patient to sit up in a comfortable position, if necessary supported by pillows.

31. Cont..
 Place the mackintosh & towel under the patients face & chin.
 Use artery forceps to clean the tongue, roof of the mouth & lips with gauze & fresh water.
 Take tooth brush & toothpaste & systematically clean the teeth. Begin on the outside of
the teeth, brush up & down.
 Place the kidney tray beside the patients mouth & help the patient to rinse the mouth &
gargle the throat with clean water.

32. Cont..
 Remove the kidney tray & wipe the patients mouth & lips with the
towel.
 If necessary, apply lubricants to the lips ( to prevent dry &
cracking)
 Mouth should be rinsed after every sweet diet.
 Make the patient comfortable.
 Remove all equipment’s from the bed side & replaced in a proper
place.
 Wash hands.
 Record the procedures & observations in the patients file. Note the
conditions of the patients mouth, tongue, lips & gums & report any
abnormalities to the nurse incharge.

33. Procedures for unconscious patient
 Collect all equipment's
 Bring the tray to the bed side.
 Wash hands & don disposable gloves.
 Greet the patient & explain the procedure.
 Maintain Proper privacy.
 Place the patient in a side lying position towards the defended side.
 Place the mackintosh & towel under the patients face & chin.

34. Cont..
 Place the kidney tray close to the chin.
 Use any dentifrice to clean the teeth.
 Do not pour water in the mouth.
 Wraps a swab around the forceps covering the lips completely &
clean the mouth systematically, clean the mouth in the following
water inside checks, gums, teeth, roof of the mouth, lips.
 Use tongue depressor if needed.
 Use as many swabs as required till the mouth is clean.
 When the teeth & tongue are cleaned well, stop the procedure,
wipe the lips & face with towel.
 Apply Boroglycerine on the cracked lips & tongue.

35. Cont..
 Remove all equipment’s from the bed side & replaced in a proper place.
 Make the patient comfortable.
 Wash hands.
 Record the procedures & report any abnormal condition to the nurse incharge
& physician.

36. Nursing care plan:
Nursing Diagnosis Goals Interventions Evaluation
Risk of injury due to
improper way of
mouth care
To Prevent injury
due to improper
way of mouth
care
• Use of soft gauze piece.
• Gently wipe the mouth to
prevent injury.
• Do not rubbing in the mouth
• Slowly wipe the mouth and lip.
• Use moisturizer to prevent
dryness
Gradually reduce the
risk of injury.
Risk of difficulty in
swallowing
To prevent
difficulty in
swallowing
 Encourage small & frequent
feeding.
 Render oral care before feeding.
 Proper positioning while feeding.
 Instruct the patient not to talk
while feeding.
Gradually the patient
can swallow
comfortably.

37. Nursing Diagnosis Goal Interventions Evaluation
Risk of oral thrush,
gingivitis, glossitis,
dental caries etc.
To prevent oral
thrush, gingivitis,
glossitis, dental caries
etc.
• Brush teeth after
each meal.
• Soak dentures
overnight in
corsodyl.
• Give antifungal
medicines
according to
doctors order.
• Early treatment
can minimize
symptoms &
prevent erosion of
mucosa & spread in
other parts of GI
tracts.
Gradually decrease
risk of oral thrush,
gingivitis, glossitis,
dental caries etc.

38. Nursing Diagnosis Goals Interventions Evaluation
Deficient knowledge about mouth
care.
Demonstrate knowledge on
mouth care
 Asses the patients
knowledge about mouth
care.
 Explain the importance of
mouth care to the patient
and relatives
 Explain about complication
delay in mouth care.
 Explain about drug regiment
and its side effects.
 Encourage patient or
relatives to maintain
cleanliness and hygiene.
 Precaution should be taken
to maintain bleeding e.g.
Used soft bristled tooth
brush.
Gradually demonstrate
knowledge about mouth care.

39. Conclusion
Mouth care is vital aspect of patient care specially for the seriously ill
patient as they usually wholly dependent on others to provide mouth care
such as in ICU. Within the ICU setting ventilator associated pneumonia is
the predominant nosocomial infection with a mortality rate of between 54%
& 71% (Grap,munro,ashitiani & Bryant,2003). So, if we want to save the
life of a patient, mouth care is crying need for them. Let’s keep our patients
smiling by improving our care & increasing education regarding mouth care.
No matter what your age -5, 25, 65, or 85 years- oral health is vital to your
general health & well-being.