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NT Skills Update - oral hygiene

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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.

Abstract

VOL: 99, ISSUE: 01, PAGE NO: 29

ASSESSMENT

  • 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.

EQUIPMENT

  • 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.
  • Receiver.
  • Box of tissues and towel.

PROCEDURE

  • 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.

OTHER CONSIDERATIONS

  • 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.

FURTHER READING
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.

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