Have you looked in your patients’ mouths recently? You may be shocked at what you see.
I have seen teeth and tongues coated in thick dried saliva and old food, a breath to knock you out, inflamed gums. Too many times it is absolutely dis-gust-ing!
It always amazes me when a patient with regular assistance for all the other ADLs (activities of daily living) somehow has slime covered teeth. It’s obvious no one has bothered to check their mouth for lo-o-o-ng periods of time.
Care enough about your patients to improve tissue integrity, remove bacteria, the possibility of secondary infection and make tasting food a pleasure again. If they happen to be an, intubated, ICU patient, maintain their oral hygiene to reduce vent associated pneumonia.
The first step is to assess your patient's condition.
There are several assessment tools but none at present are standard, validated tools. However, you need to start somewhere so if your facility doesn't have a particular tool, try:
These nursing education videos go through the general aspects of mouth care and denture care.
Yes there will always be the confused patient too combative to get to brush their teeth from time to time, but as a general rule, daily oral hygiene can be done with a little persistence and time.
Note: One of the biggest losses for a patient in a facility is dentures! Before throwing anything out or removing dinner trays from a room, make sure you aren’t throwing out a pair of dentures with the other stuff!
An example of one brand's oral care system:
Don’t underestimate how much saliva can dry and stick to the oral mucosa. Be thorough but gentle.
While this video shows applying lubricant to lips after the procedure, if the lips are dry, apply a lubricant before opening the mouth to avoid pain and tearing of the skin.
Usually, in ICU mouth care is performed Q2H (every 2 hours) or Q4H (every 4 hours).
For limited mouth opening, use a mouth prop, such as the handle of a large denture brush. Inspect the oral cavity with a penlight. What you find determines how often mouth care should be performed.
Use a soft pediatric, suction or electric toothbrush depending on what your facility offers. The sponge toothettes have been found to be ineffective for removal of tartar or other debris from the teeth.