oral hygiene

oral care

Oral hygiene is the process of keeping the patient's mouth clean by brushing to prevent mouth infection, odour, and improve patient comfort. Proper oral hygiene enhances patient comfort, appetite, communication, and overall health, especially in bedridden, unconscious, and critically ill patients

indication or reason for oral hygiene

• to prevent oral infection that can come as a result of poor oral care
• to treat oral infection like candida, oral odour
• preventing the oral mucous membrane from becoming dry and cracked
• to maintain oral hygiene among bedridden patients 
• to provide comfort to both the nurse and the patient when communicating
• to prevent sores that result in ulcerations
• prevent dental caries and tooth decay
• prevent complications like glossitis, stomatitis
• stimulate circulation in the gum, thus maintaining healthy firmness
• increases appetite in a patient who has lost appetite
• stimulate salivation. increase the production of saliva to keep the mouth moist
• to remove food which has remained in the teeth after eating
• prevent bad breath, ie halitosis

The patient who may require oral care

• patients who are unconscious or semi-conscious.
• paralysed patient because they are helpless to themselves.
• patient with acute illness and a seriously ill patient.
• post-operative patient after anaesthesia.
• pre-operative patient,  especially a patient having an operation in the mouth.
• patient with higher pyrexia
• patient on nil per os, ie patient not taking anything by mouth.
• patient with malnutrition to boost the appetite
• patient with local disease of the mouth, eg oral thrush , gum infections
• paraplegic patient
• dehydrated patient.

complication of a neglected mouth

local complications

• stomatitis

This is the inflammation of the mucus membrane of the mouth

• givitis

This is the inflammation of the gum

• glossitis

this is the inflammation of the tongue

• dental carries

This is also known as tooth decay.it is a bacterial infection eating up the tooth

• root abscess

This is the presence of pus at the root of the teeth.

• periodontal disease

This is also called pus or pyorrhea, which means the formation of pus in the tooth socket

• bleeding gum

This is the bleeding from the gum.

complications of the neighbouring structures of the mouth

• parroditis

this is the inflammation of the parotid gland

• rhinitis

this is the inflammation of the sinus cavity.

• otitis media

this is the inflammation of the middle ear

• tonsillitis

this is the inflammation of the tonsils

• adenitis

Inflammation of the adenoid.

systemic complications

anorexia

This is simply the loss of appetite or lack of appetite

bacterial endocarditis

Inflammation of the endocardium due to bacterial infection from the teeth.

gastritis

this is the inflammation of the mucus membranes of the stomach

nephritis

inflammation of the kidneys

rheumatic arthritis

inflammation of the joints

requirement for oral care or oral hygiene for the patient

a tray containing the following

1. a galipot of sodium bicarbonate
2. a galipot of glycerine and borax
3. container for artery forceps and non-tooth dissecting forcep (two artery forceps and two non-tooth dissecting forcep.
4. galipot of cotton
5. a receiver for used glove
6. a receiver for used mouth piece
7. a receiver for waste water
8. a bottle of sodium bicarbonate
9. a bottle for glycerine and borax
10. a glass of water or mouth wash
11. mouth piece in a galipot
12. glove
13. a mackintosh and a towel.
14. apron
15. mask
16. a bowel of denature if needed

bed side

1. screen
2. hand washing equipment

Procedure for carrying out oral hygiene for a conscious patient

1. explain the procedure to the patient for easy cooperation and trust building
2. provide privacy using the screen, providing comfort
3. Bring the tray to the bedside for easy access of the equipment
4. Position the patient in a sitting-up position 
5. Place the Mackintosh and the towel at the head of the patient to protect the patient's bedding and clothes.
6. Wash your hands and put on gloves to protect both the nurse and the patient from cross-infections.
7. remove the patient's denature if the patient has them, clean and put them in the bowl of water
8. Inspect the mouth note and report any abnormalities
9. Pick the cotton using artery forceps and dip it in the cleaning solution(sodium bicarbonate)
10. Squeeze it using non-toothed dissecting forceps to prevent dripping.
11. clean the outer and the inner surface of the teeth and change the cotton
12. clean the gum and change the cotton
13. clean inside the cheek and change the cotton
14. clean the tongue gently
15. clean the teeth from the root up ward but avoid touching the soft palate
16. Give the patient water or mouthwash to rinse the mouth.
17. Wipe the lips with a dabbing movement and apply glycerine
18. Thank the patient and leave the patient comfortably
19. clear away
20. document

requirement for oral care for unconscious patient

a tray containing the following

1. a galipot of sodium bicarbonate
2. a galipot of glycerine and borax
3. container for artery forceps and non-tooth dissecting forceps (two artery forceps and two non-tooth dissecting forceps.
4. galipot of cotton
5. a receiver for a used glove
6. a receiver for used mouthpiece
7. a receiver for waste water
8. a bottle of sodium bicarbonate
9. a bottle for glycerine and borax
10. a glass of water or mouth wash
11. mouth piece in a galipot
12. mouth gag
13. tongue depressor
14. glove
15. a Mackintosh and a towel.
16. apron
17. mask
18. a bowel of denature if needed

bed side

1. screen
2. hand washing equipment

Procedure for carrying out oral hygiene for an unconscious patient

1. explain the procedure to the patient and attendant for easy cooperation and trust building
2. provide privacy using the screen, providing comfort
3. Bring the tray to the bedside for easy access to the equipment
4. Position the patient in a sitting-up position 
5. Place the Mackintosh and the towel at the head of the patient to protect the patient's bedding and clothes.
6. Wash your hands and put on gloves to protect both the nurse and the patient from cross-infections.
7. Remove the patient's denature if the patient has them, clean and put them in the bowl of water.
8. Open the mouth using a mouth gag
9. Using a tongue depressor, depress the tongue from falling back to block the airway
10. Inspect the mouth note and report any abnormalities
11. Pick the cotton using artery forceps and dip it in the cleaning solution(sodium bicarbonate)
12. Squeeze it using non-toothed dissecting forceps to prevent dripping.
13. clean the outer and the inner surface of the teeth and change the cotton
14. clean the gum and change the cotton
15. clean inside the cheek and change the cotton
16. clean the tongue gently
17. clean the teeth from the root up ward but avoid touching the soft palate
18. Rinse the mouth.
19. Wipe the lips with a dabbing movement and apply glycerine
20. Thank the patient and leave the patient comfortably
21. clear away
22. document

conclusion

Nurses perform oral hygiene for conscious and unconscious patients using aseptic technique, proper positioning, infection-control measures, and appropriate equipment such as sodium bicarbonate solution, cotton swabs, forceps, mouth gag, and protective equipment.