Definition
Assisting a conscious patient with oral hygiene is a key nursing task that promotes comfort, dignity, and infection prevention.
Indications
- Mouth breathers.
- Patients on NPO.
- Oral surgery patients (sterile special mouth care).
- Patients on oxygen inhalation.
- Children under 3 years.
- Patients who are unable to maintain adequate oral hygiene.
Purposes
- To maintain the healthy state of mouth, teeth, gums, and lips.
- To clean the mouth off food particles, plaque, and bacteria.
- To relieve discomfort resulting from unpleasant odors and tastes.
- To enhance the well-being and comfort and to stimulate appetite.
- To prevent sores, caries, and infection to oral tissues.
Complications of Neglected Mouth
- Inflammation in various localized regions of the oral cavity. For example, halitosis, glossitis, pyorrhea, root abscess, parotitis, sordes and crust, dental caries, adenitis, tonsillitis, etc.
- Loss of appetite
- Joint diseases
- Rheumatic heart disease
- Gastritis.
Articles
A clean “mouth toilet tray” containing:
- Face towel.
- Tumbler/feeding cup containing water
- Soft bristled toothbrush.
- Toothpaste/tooth powder/available dentifrice.
- Mouth wash solution (according to patient’s preference and availability).
- i. Sodium chloride
- ii. Thymol
- iii. Diluted solution of potassium permanganate 1:1,000
- iv. Listerine
- v. Chlorhexidine.
- Cotton applicators/cotton balls.
- Emollient in a container-glycerin, liquid paraffin, Vaseline, and coconut oil.
- K-basin/emesis basin (2 nos.).
- Small mackintosh.
- Clean gloves.
Procedure
| NURSING ACTIONS | RATIONALE | |
| 1. | Before procedure Assess the condition of the patient, his mouth, and the level of consciousness. | Helps to determine the type of oral hygiene the patient requires. |
| 2. | Inspect the integrity of lips, teeth, buccal mucosa, gums, palate, and tongue. | Determines the status of the patient’s oral cavity and the extent. of need for oral hygiene. |
| 3. | Assess the patient’s ability to grasp and manipulate toothbrush. Explain the procedure to patient and encourage him to participate. | Determines the level of assistance required. Reduces anxiety and promotes patient participation. |
| 4. | Pull the screen. | Provides privacy. |
| 5. | During procedure Wash hands and don gloves. | Prevents spread of infection. |
| 6. | Bring the patient to the edge of the bed nearest to the nurse. | Promotes correct body mechanics and ease of working. |
| 7. | Position patient in high Fowlers/semi-Fowlers position as tolerated. | Provides comfortable working position. |
| 8. | Place the small mackintosh with the face towel on the chest. | Prevents patient’s clothing from soiling. |
| 9. | Place K-basin close to the patient’s chin. | Prevents soiling. |
| 10. | Apply toothpaste to brush. Holding brush over K-basin, pour small amount of water over toothpaste. | Moisture aids in distribution of toothpaste over tooth surface. |
| 11. | Instruct patient to hold toothbrush bristles at 45o to gum line. Brush inner and outer surfaces of upper and lower teeth by brushing from gum to crown of each tooth. | Angle allows brush to reach all tooth surfaces and to clean under gum line where plaque and tartar accumulate. |
| 12. | Clean the biting surface back and forth: farther side first and then nearer side and upper jaw first and then lower jaw. | Back and forth motion dislodges food particles caught between teeth and along chewing surface. |
| 13. | Have the patient to hold the brush at the same angle (45o) over tongue and brush lightly over surface horizontally taking care not to initiate gag reflex. | Microorganisms collect and grow on tongue surface and contribute to bad breath. Gagging may cause aspiration of toothpaste or may induce vomiting. |
| 14. | Allow patient to rinse mouth thoroughly by taking mouthful of water and spitting into the K-basin. | Vigorous swishing motion helps to remove debris and toothpaste. |
| 15. | Allow patient to rinse mouth with mouthwash as desired. | Mouthwash leaves a pleasant taste in mouth. |
| 16. | Assist wiping mouth with face towel. | Promotes sense of comfort. |
| 17. | Apply emollient to lips. | Prevents cracking and drying of lips. |
| 18. | Assist patient to comfortable position. | |
| 19. | Discard the waste, clean the used articles, and replace equipment as appropriate. | Leaves the unit clean and articles ready for further use. |
| 20. | Wash hands. | |
| 21. | Record the procedure including time, solution used, and condition of mouth. |
Paediatric Variations
Positioning
- Stand with the child’s back toward the adult. When in front of a mirror, both child and adult can see what is being done in the mirror.
- Sit on a couch or bed with the child’s head resting in adult’s with lap with face up.
- Sit on the floor with child’s head resting between adult’s thighs.
Brushing
- The most suitable method for cleaning primary teeth is scrub method.
- The tips of bristles are placed firmly at 45° angle against the teeth and gums and moved back and forth in a vibratory motion.
- The ends of the bristles should be wiggling but not moving forcefully back and forth.
- All the surfaces of teeth are cleaned in this manner except inner surfaces of anterior teeth.
- To clean inner surfaces, place toothbrush vertical to the teeth and move up and down.
- Use 6 – 8 strokes for each section of teeth.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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