INTRODUCTION
Certain patients are prone to oral problems because of lack of knowledge. Good oral
hygiene includes cleaning gums & brushing of teeth.
DEFINITION
Oral hygiene means cleaning the teeth & the oral cavity of the patient. It includes the
measures to prevent the spread of disease from the mouth & increase the comfort of
the patient.
PURPOSE
To maintain the healthy state of mouth, gums, teeth & lips.
To remove food particles from & between the teeth
To provide sense of wellbeing
To prevents sores & infection of the oral tissues.
To remove dental plaque.
To stimulate appetite.
To relieve discomfort resulting from unpleasant, odour & taste
To prevent gum inflammation & infection .
To prevent the mucous membrane from becoming dry.
INDICATIONS
Mouth breathers
Pts on NPO/NBM
Oral surgery patients
Patients on oxygen inhalation
Children under 3 years
Patients who are unable to maintain adequate oral hygiene
Patients with fever
Patients on tube feed
Postoperative patients
Paralyzed patients
Patients under anesthesia
Dehydrated Patients
Unconscious patients
Patients receiving chemotherapeutic agents or drugs/ under radiation therapy.
Diabetic patients
Anatomy & Physiology of Oral Cavity
ARTICLES REQUIRED
Articles needed for conscious patients:
Face towel
Disposable gloves (clean)
Toothpaste
Emollients (liquid paraffins, coconut oil, boroglycerine vaseline
Cotton applicator.
Mackintosh with draw sheet
Toothbrush
Jug of tepid water
Figure 1: Tray for oral hygiene (conscious patient)
MOUTH WASH SOLUTION AND EMOLLIENTS COMMONLY USED
Mouth wash solution commonly used:-
Sodium chloride 1 tsf to 1 pint water
Diluted solution of KMNO4 1:5000/one crystal to a glass of water
Chlorhexidine
Lemon juice two spoons to a cup of water
Hydrogen peroxide(1:8)
Emollients used: Cream or butter
Vaseline
Boroglycerine
Liquid paraffin
Olive oil
PREPARATION OF THE PATIENT
Check the conditions of oral cavity
Check the ability of the patient for self-care
Check general condition of the patient
Determine frequency of mouth care needed Keep in mind doctors instructions for
specific precautions regarding the movement and positioning of patient.
Take all the articles to the patient's unit
Explain procedure to the patient, if conscious to ga his cooperation and
confidence
Maintain a safe and comfortable position for the mouth care sitting or in fowler's
position with a cardiac table
Place a mackintosh and a face towel across the chest and under the chin to
protect bed cloths and garments
Arrange the articles conveniently
Provide privacy screen patient
STEPS OF THE PROCEDURE
S. No. STEPS OF THE RATIONALE
PROCEDURE
1 Wash hand To
prevent the transfer of
pathogen from source to
the new host.
2 Proper mouth wash by Kmno4 acts as an
adding hot or cold water antiseptic and deodorant.
and drop the crystal of
kmno4 into it.
3. Helps the patient to rinse To moisten the mucus
his mouth with water membrane and prevent
tissue trauma while
brushing.
4 Wetting the brush makes
Pick up the toothbrush, bristles soft
wet it with water apply
tooth paste and hand it
over to the patient
5 o Instruct the patient to o Ensure through cleaning
brush all sides of teeth out proper brushing
side, inner side, right, left minimizing the risk of oral
side, chewing surface infection
extending from gum to
enamel
6 o When the patient finishes o Immediate washing of
brushing pour water on the brush ensures thorough
brush holding it over cleaning and is ready for
kidney tray clean the brush use next time
and place it back o Thorough rinsing
o Help the patient to rinse ensures thorough cleaning
his mouth thoroughly
7 o Ask the pt to massage o Massaging the gum
the gums with thumb and stimulates circulation and
index finger over the ridge toughness the oral mucus,
of the gum using a press there by increasing
and release motion resistance to tissue
trauma
8 o Help the pt to wash his To clean the face and
face and hands and wipe prevent infection
with towel
Apply emollient To soothe and soften the
mucus membrane.
TERMINATION OF PROCEDURE
Remove the kidney tray, mackintosh and towel .
Make the patient comfortable .
Tidy up the unit .
Record the time and nature of treatment and the condition of the patient's mouth
on the nurse's record
Discard the waste and clean articles w soap and water
Wash hands
COMPLICATIONS OF NEGLECTED MOUTH
LOCAL COMPLICATIONS
Halitosis
Stomatitis
Pyorrhea
Root abscess
Tonsillitis . Sinusitis
Parotitis
Glossitis
Sordes
Adenitis
Otitis media
Dental caries
GENERAL COMPLICATIONS
loss of appetite
inhalation Pneumonia
Nephritis
Joint disease
Rheumatic heart disease .
Gastritis
PREVENTION OF COMPLICATION
Through rising after brushing is important to remove dislodged food particles
and excessive tooth paste.
Mouth wash gives a pleasant taste but used over a long period dries mucosa.
Mouth wash should never be taken directly from bottles. It can cause cross
infection.
Through brushing of teeth at least four times a day (after each meal and at bed
time) is basic to effective oral hygiene programme.
To prevent tooth decay in the diet reduce the intake of carbohydrates. ex- sweet
snacks between meals
A well balanced diet ensures integrity of oral tissues. One should have a good
intake of fluids.
Patient with diabetes should visit the dentist every three - four month .
All times should be handled with minimum trauma.
Patients at risk of stomatitis for example patient on chemotherapy, radiation and
nasogastric tube should rinse their mouth before and after each meal using a
solution containing 1/2 to 1 tsf of salt or baking soda to 1 pint of water.
Liquid topical antibiotics can be applied on buccal surface.
ORAL HYGIENE FOR INDEPENDENT PATIENT
Patient who are able to sit in a Fowler's or semi Fowler’s position can perform
their own oral hygiene.
Patient can sit on the edge of the bed or stand at the sink
A nurse should observe the process and provide any necessary teaching about
brushing and flossing.
A nurse should discuss the importance of good oral hygiene and health.
ORAL HYGIENE FOR DEPENDENT PATIENTS
Check the level of assistance required for dependent patient.
Patients ill, have surgery or medical condition that inhibits the use of hands.
ORAL HYGIENE FOR UNCONSCIOUS PATIENTS
Best position is side-lying with patient's head turned toward you in either a semi-
Fowler's position or with the head of the bed flat.
Use a soft-bristled toothbrush and toothpaste
Use a syringe and water to rinse the teeth and tongue.
Use foam swabs moisten with diluted hydrogen peroxide or other solution to
remove crusts and secretions from the mucous membranes of the mouth.
Be sure to suction any secretions that pool in the patient's mouth during
procedure.
Perform a thorough assessment of cavity each time.
Do proper record and report.
CARE OF DENTURES
o Care of dentures of artificial teeth is the responsibility of the nurse.
Equipment Needed:
Soft bristled tooth brush
Denture tooth brush
Dentrifrice
Warm and cold water in glass
Gauze pieces
Wash cloth
Plastic denture cup
Gloves
Basin
CARE OF DENTURES
Explain and secure the cooperation of the patient o Remove the denture and
inspect the oral cavity for abnormalities if any .
Wash hands and keep the articles near the bed side sink .
Take a basin and fill half of it with water .
Put on gloves to reduce transmission of infection . Ask the patient to remove
dentures and place them in the basin .
Brush the dentures. Use back and front motion. Clean inside and outside by
brushing .
Rinse dentures thoroughly in running water.
Return them to the patient to keep them in a denture cup in cold water o
With a soft bristled tooth brush the gum with tooth paste as well as the palate of
tongue also .
Rinse the mouth thoroughly with cold water .
Wipe the face and make the patient comfortable.
PRECAUTIONS
In cleaning dentures, they should be held firmly to avoid slip or fall down
Denture should be dipped in cold water to prevent friction
Hot water may destroy dentures
Privacy should be maintained
Avoid hard bristle brush
If the patient is capable of self care arrange the articles
Encourage the patient to wear dentures in day
Avoid to wear dentures in seriously ill patient, patient under anesthesia,
unconscious patient for preventing dislodging or blocking the respiratory
passage
Denture should be stored in a labeled container to prevent lost and breakage.
