Mouth Care
- Published: 21 June 2007 18:16
- Last Updated: 19 September 2007 11:55
Gail P. Mooney, MSc, PG Social Research Methods, RGN, lecturer, School of Health Science, University of Wales, Swansea.
Why is it done? Why is it done? Maintaining a clean and comfortable oral cavity helps patients to recover and reduces the risk of their health declining. They will be able to communicate better, eat more easily and will maintain dignity. Equipment needed: • Micro touch gloves, tongue depressor and torch for examining mouth; • A small, soft bristle toothbrush; • Fluoride toothpaste; • Foam sponge sticks; • Plastic disposable beaker; • Jug of water; • Receiver; • Box of tissues and towel. How is it done? First explain to the patient what you are going to do. Examine the patient’s mouth wearing gloves and an apron. Use a torch to help you see into the back of the patient’s mouth. If applicable move the patient’s dentures. Use the RMB Assessment tool (Rattenbury et al, 1999). The most effective aid for maintaining dental and gingival health is a toothbrush (Pearson and Hutton, 2002). Procedure • Always use fluoride toothpaste. The brush should have a small head with evenly spaced, soft bristles. • Do not use too much toothpaste – it just fills the mouth with froth. Use the equivalent of the size of a small pea. • If possible take the patient to the bathroom to use the sink. If a patient is bed bound, a receiver or similar receptacle under the patient’s chin can be used. • It is easier to stand behind the patient when you clean their teeth, if they are able to sit in a chair. For patients confined to bed you have to stand to one side of the bed. • Top teeth – The position and angle of the brush is very important when cleaning the teeth. Hold the brush at an angle of 45˚ to the tooth. • Bottom teeth – the same angle of 45˚ is used for the lower teeth. • Move the brush in a circular motion. Clean the gums next to the teeth as well. Note: if gums bleed its because plaque has previously been allowed to build up. If they are inflamed do not avoid brushing the gum. The gums may bleed because plaque has previously been allowed to build up. Proceed to clean the gums gently. If there is excessive bleeding from the gums report to the doctor. There may be an underlying medical problem e.g. clotting disorder • Clean the inside surfaces of the teeth – keep the same 45˚ angle. • Hold the brush this way for the backs of the front teeth – top and bottom. • Finally do not forget the biting surfaces of the teeth • The brush can also be used to clean the tongue. If patient has no teeth then the gums and tongue can be cleaned with a toothbrush. • The patient can rinse their mouth if they wish but it is not necessary – in fact leaving the toothpaste on the teeth gives them protection for longer. • Cleaning dentures – Clean dentures with toothbrush and toothpaste. Always clean dentures over a sink with some water in the bottom – if you drop them this will prevent them from breaking. • Use a lip balm for dry cracked lips. • The toothbrush should be washed in clean water and left to dry before storage. • Additional protection of goggles, mask, apron and gloves should be worn if patient is immune suppressed or if the patient has a highly infectious communicable disease. Recommended solutions| Oral care product | When recommended |
| Sodium bicarbonate Dilute one teaspoon in 500mls of warm water Use once and discard | When tenacious mucous is present or mouth is crusted |
| Glycerine/thymol tablets 1 tablet to a beaker of water | Useful for refreshing mouth, plays no part in cleaning. Effect lasts 20 seconds |
| Corsodyl Rinse the mouth with 10mls for about one minute twice a daily | Highly recommended, inhibits bacterial growth |
| Nystatin 100,000 units four times daily after food, usually for seven to nine days If patient wears false teeth, remove before introducing | Oral fungal infections |
| Toothpaste Use small amount on toothbrush | Highly recommended |
| Tap water Refreshing – ideal pH of seven | Recommended to moisten mouth |
| Pineapple cubes/juice Tinned variety tolerated better than fresh | Ideal for dry mouths, contains a proteolytic enzyme ananse that cleans the mouth |
| Emollient (vaseline) Apply to lips only | Prevent lips cracking |
| Lip balm Apply to lips only | Prevents lips cracking, easy- to –apply flavoured balms available |
