Purposes.

• Provide oral care of the teeth, gums, and mouth.
• Remove offensive odors and food debris.
• Promote patient comfort and a feeling of well-being.
• Preserve the integrity and hydration of the oral mucosa and lips.
• Alleviate pain and discomfort, thereby enhancing oral intake.

General Guidelines.

Oral hygiene should be performed before breakfast, after each meal, and at bedtime.

Oral hygiene is especially important for patients receiving oxygen therapy, patients who have nasogastric tubes, and patients who are NPO. Their oral mucosa dries out much faster than normal due to their mouth-breathing.

You should provide for patient privacy during the procedure, as this is an extremely personal procedure for most patients.

Oral care for the unconscious patient should be performed at least every four hours.

Lipstick, chap stick, or vaseline may be applied to the lips to keep them from drying out.

Nursing Records.

Nursing observations for the patient’s mouth should be recorded in the clinical record, noting such factors as:

• Bleeding.
• Swelling of gums.
• Unusual mouth odor.
• Effect of brushing the teeth. Note if there is bleeding when you brush the patient’s gums and teeth.

Conscious Patients with Dentures.

General considerations.

Many patients are sensitive or embarrassed about wearing dentures; therefore, the patient’s privacy should be respected when the dentures are cleaned.

Dentures must be handled carefully; they are fragile and expensive, and the patient is handicapped without them.

If the dentures are left out of the mouth for any period of time, place them in a covered opaque container with the patient’s name on the container.

Dentures must be kept in water to preserve their fit and general quality; the color may change if they become dry.

You may avoid breaking the dentures while cleaning them by holding them over a basin of water with a washcloth folded in the bottom.

Dentures are brushed in the same way as natural teeth; be sure to rinse them well.

The denture cup should be labeled with the patient’s name and room number.

Never use hot water to rinse the dentures as it could warp them; use cool or lukewarm water.

The patient’s gums and soft tissues should be cared for at least twice per day while the dentures are out of the mouth; a soft-bristled toothbrush, swab, or gauze-covered tongue blade dipped in mouthwash should be used to cleanse the gums, tongue, and soft tissues.

Patients With Mouth Complications.

The following problems are common in patients receiving chemotherapy and radiation therapy:

• Bleeding.
• Observe the patient’s mouth frequently for the amount of bleeding present and the specific areas.
• Do not floss the patient’s teeth; use a Water-pik®.

Brush the teeth and clean the mouth using one of the following methods:

1 Brush the teeth carefully with a very soft toothbrush.

2 Wrap a tongue blade with a gauze sponge saturated with a prescribed solution; carefully swab the teeth and mouth. Do not use lemon/glycerine swabs or commercial mouthwash because they contain alcohol, which causes burning.

Infection.

Observe the patient’s mouth for appearance, integrity, and general condition.

Wear clean gloves during the procedure.

Obtain a culture, if ordered.

Do not floss the teeth if the mouth is irritated or painful.

Assist the patient with brushing the teeth and cleaning the mouth, using a soft toothbrush or a gauze-padded tongue blade.

Rinse the mouth with water and the prescribed solution, if ordered.

Ulcerations, to include stomatitis.

• Basic procedure for the patient with an infection should be followed.
• If the patient’s mouth is extremely painful, rinsing the mouth with a local anesthetic, as prescribed by a physician, may be necessary.
• Mouthwash and other solutions which contain alcohol should not be used for the patient with ulcerations as they are frequently very painful.

Unconscious Patients.

Oral care should be performed at least every four hours.

Oral suctioning may be required for the unconscious patient to prevent aspiration.

A soft toothbrush or gauze-padded tongue blade may be used to clean the teeth and mouth.

The patient should be positioned in the lateral position with the head turned toward the side to provide for drainage and to prevent aspiration.