MOUTH CARE

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MOUTH CARE
Chapter 12

• Mary Clynes

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Introduction

• This presentation examines the requisite standard
  of mouth care within the healthcare setting and
  walks you through relevant, mouth care related
  procedures.
• Part 1 Mouth Care Overview and Procedure
• Part 2 Mouth Assessment Procedure
• Part 3 Brushing a Patients Teeth

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• PART 1 Mouth Care Overview and Procedure

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Mouth Care

• Mouth care, or oral hygiene, is the provision of
  appropriate care to ensure that the tissues and
  structure of the mouth are in a healthy state.
• Mouth care involves oral assessment, appropriate
  mouth care, evaluation of care and documentation
  of care.
• Mouth care is a fundamental aspect of nursing.
• Effective mouth care prevents both potential oral
  and systematic infection, as well as distress and
  discomfort to the patient (Xavier, 2000).

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Aims of Mouth Care

• Prevent the build up of food and plaque on teeth
  and gums, thus preventing dental caries.
• Prevent infection due to the build up of bacteria
  in dental plaque.
• Ensure that the mucosa remains clean, moist and
  intact .
• Keep the lips moist, smooth and pink, thereby
  preventing chapping of lips.
• Alleviate discomfort and promote well-being by
  refreshing the mouth.
• Prevent halitosis (bad breath).
• Maintain oral function.

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Patients

• Patients who may require mouth care include
• Patients who are on a reduced intake of fluids
  and nutrients, or patients who have not eaten or
  drunk for a period of time.
• Ventilated or sedated patients in intensive care
  units.
• Patients undergoing chemotherapy.
• Patients undergoing radiotherapy to the head or
  neck region.
• Patients on oxygen therapy.
• Elderly patients.
• Patients who are taking immunosuppressive
  medications.

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Equipment

• Clean tray
• Plastic beaker
• Bowl/receiver/kidney dish
• Small headed soft toothbrush
• Toothpaste
• Spatula

• Pencil torch
• Tissues
• Clinical waste bag
• Disposable gloves (non-sterile)
• Apron

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• Medication, if prescribed e.g an antifungal agent
  if the patient has oral thrush (candida albicans)
• Sterile mouth care pack may be used when
  intensive mouth care is needed for patients for
  whom tooth-brushing and mouthwashes are
  inappropriate (Jamieson et al, 2002).
• Lubricant for lips

• Denture cleaner
• Piece of gauze to remove dentures
• Container for dentures and label
• Mouth wash if appropriate
• Foam swabs if appropriate
• Suction if appropriate
• Protective sheet or towel

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Procedure for Mouth Care

• Collect and prepare the equipment in order to
  carry out the procedure smoothly and without
  unnecessary stoppages.
• Wash hands and put on gloves and apron to prevent
  contamination with body fluids (saliva) and
  reduce the risk of cross-infection.
• Explain the procedure to the patient in order to
  gain consent and co-operation.
• Pull curtains around bed to ensure privacy. Mouth
  care is both an invasive procedure and a
  potentially embarrassing interaction.
• Ensure the patient is in a comfortable position,
  either in bed or sitting on a chair with a bowl
  in front of him/her.

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• Position unconscious patient on his or her side.
• Remove pillow, lower head of bed if possible and
  support head. This ensures that secretions or
  mouth wash are drained out of the mouth with
  gravity and not aspirated into the lungs.
• Have an oral suction at hand to remove excess
  fluids that may pool in the side of the mouth.
• Place towel or protective cover over patients
  chest to protect clothes.
• If the patient is unconscious, cover the bed with
  a waterproof cover and towel.

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• Ask the patient, or assist with the removal of
  dentures to gain access to the oral cavity to
  view the area.
• Important to involve the patient as much as
  possible in care, in order to promote
  individualised care and feelings of independence.
  
• Condition of the dentures should be observed,
  noting any stained, cracked or warped areas.
• Patient may be self-conscious when dentures are
  removed.

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• Cleaning another persons teeth is an invasive
  and potentially embarrassing procedure, therefore
  let someone else clean your teeth to know what it
  feels like (Holman et al, 2005). Frequency of
  oral care is determined by oral assessment
  (Kinley Brennan, 2004).
• Garcia (2004) recommends that oral care should be
  provided every two hours for intensive care
  patients, and at least every four hours after
  each meal in other areas.

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PART 2 Mouth Assessment Procedure
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Assessment of Mouth

• Check for
• Inflammation and bleeding of gums.
• Ulcers and white or yellow areas of mouth and
  tongue.
• Dental decay.
• Coating of tongue and dry mucous membranes.
• Quality and quantity of saliva.
• Halitosis.
• Cracked, dry or ulcerated lips.
• Whether patient has difficulty chewing,
  swallowing or speaking.

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• PART 3 Brushing a Patients Teeth

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Procedure for brushing teeth

• Furring of the tongue can be removed by brushing
  the tongue with a soft toothbrush and toothpaste
  (Nazarko, 2006).
• Do gently, to preventing gagging and subsequent
  vomiting.
• Offer the patient a beaker of water and encourage
  vigorous rinsing of the mouth to remove debris
  and toothpaste from the mouth.
• Explain to patient that mouthwash should not be
  swallowed.
• Unconscious patient
• - Place a curved dish (e.g kidney dish) against
  chin and lower cheek so that fluid can easily
  flow into dish (Kozier et al, 2004).

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• Floss teeth once a day to remove plaque and food
  particles from between teeth and under gumline
  (Clay, 2000).
• Clean the dentures on all surfaces with a
  toothbrush and denture cleaning agent.
• Rinse well to remove traces of cleaning agent.
• Return to patient or place in a container of
  water when not in use.
• Ensure that container is labelled with patients
  name and hospital identification number to
  prevent mix-ups.

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• Ensure the area around the patients mouth is
  clean and dry, as fluoride residue may irritate
  the skin (Hampton Collins, 2003).
• Apply petroleum jelly to dried, cracked or
  ulcerated lips
• It acts as an occlusive barrier which retains
  moisture (Gibson Stone, 2004).
• Do not use petroleum jelly if patient is
  receiving oxygen therapy, because it may cause
  burns to the skin and mouth (Kozier et al, 2004).
• Rinse the toothbrush and store. Dry in room
  temperature (Efstratiou, 2007).
• Dispose of any disposable material to maintain
  safety and prevention spread of infection.
• Document care provided and report any changes in
  condition to the medical team.