MOUTH CARE. Mary Clynes. Chapter 12. 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
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).
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.
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.
Patients who are taking immunosuppressive medications.
Small headed soft toothbrush
Clinical waste bag
Disposable gloves (non-sterile)
Medication, if prescribed e.g an antifungal agent if the patient has oral thrush (candida albicans)
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.
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 patient’s chest to protect clothes.
If the patient is unconscious, cover the bed with a waterproof cover and towel.
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.
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.
Inflammation and bleeding of gums.
Ulcers and white or yellow areas of mouth and tongue.
Coating of tongue and dry mucous membranes.
Quality and quantity of saliva.
Cracked, dry or ulcerated lips.
Whether patient has difficulty chewing, swallowing or speaking.
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.
- 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).
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 patient’s name and hospital identification number to prevent mix-ups.
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.