Ensuring a patient’s mouth is kept clean and healthy is essential. If a patient’s mouth is unclean it causes discomfort and can lead to infection. Therefore, a patient’s mouth should be assessed and cleaned as appropriate.
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- First explain to the patient what you are going to do.
- While wearing gloves and an apron, examine the patient’s mouth. Use a torch to see into the back of the patient’s mouth and if necessary remove the patient’s dentures.
- Use the assessment tool (Rattenbury et al, 1999) to make an accurate assessment, and identify and plan nursing interventions.
- Micro-touch gloves, tongue depressor and torch for examining the back of the mouth.
- A small, soft bristle toothbrush.
- Fluoride toothpaste.
- Foam sponge sticks.
- Plastic disposable beaker.
- Jug of water.
- Box of tissues and towel.
- If possible take the patient to the bathroom to use the sink. If a patient is bed-bound, a receiver or similar receptacle can be used under the patient’s chin.
- For patients who are able to sit in a chair, it is easier to stand behind them when you clean their teeth. For patients confined to bed, stand to one side of the bed.
- Always use fluoride toothpaste. The brush should have a small head with evenly spaced, soft bristles.
- Do not use too much toothpaste - it will fill the mouth with froth. Use a pea-sized amount.
- The position and angle of the brush is very important when cleaning the teeth. Hold the brush at an angle of 45 degrees to the teeth (top and bottom).
- Move the brush in a circular motion. Clean the gums next to the teeth as well.
- If the gums bleed it is because plaque has been allowed to build up. If they are inflamed do not avoid brushing them. Clean the gums gently - keep the area clean and the bleeding will lessen as the gum becomes healthier. Report excessive bleeding to the doctor. There may be an underlying medical problem such as a clotting disorder.
- Clean the inside surfaces of the teeth - at a 45 degree 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 patient can rinse their mouth if they wish but it is not essential. Evidence shows it is best to leave the toothpaste on the teeth - it protects them for longer.
- The toothbrush should be washed in clean water and left to dry.
- You can use the brush to clean the tongue, too. If the patient has no teeth then the gums and tongue can be cleaned with a toothbrush.
- Clean dentures with a toothbrush and toothpaste. Always clean them over a sink with some water in the bottom - this will prevent them breaking if they are dropped.
- Use a lip balm for dry cracked lips.
- Additional protection of goggles and mask should be used if the patient is immune-suppressed or has a highly infectious communicable disease.
Clancy, J., McVicar, A.J. (2002)Physiology and Anatomy: A Homeostatic Approach. London: Arnold.
Hinchliff, S. et al (2000)Physiology for Nursing Practice. London: Bailliere Tindall.