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Mouth & Dental Care and Maintaining Oral Care

Written by Amanda R. McDaniel, MS, BSN, RN
Amanda is a BSN/RN with a MS in Physiology and a BA in English. She worked as a medical writer in the pharmaceutical industry for 11 years before pursuing a career in nursing. She now works as a nurse on a NeuroTelemetry unit and continues to write and edit on a freelance basis. Amanda’s LinkedIn

Oral hygiene is about more than good breath. For patients, it can increase their sense of well-being and normalcy, as well as help ensure that they can easily consume food.

Providing Oral Care

  1. Gather your supplies.
    • Gloves
    • Emesis basin
    • Towels
    • Toothbrush with soft bristles or mouth cleaning swab/sponge
    • Toothpaste
    • Dental floss
    • Alcohol-free antiseptic mouth wash
    • Water glass with water and a straw (check that the patient is allowed straws)
  2. Introduce yourself to the patient, perform hand hygiene, and put on gloves. Close the door or draw the curtain to ensure patient privacy.
  3. Ask the patient what they feel comfortable doing and what they would like assistance with.
  4. Raise the bed to a height that is comfortable for you to work with, at least 45 degrees. Place a towel over the patient’s chest. Lay a towel on the bedside table and position the table over the patient’s lap. Place your supplies on the table so they are in easy reach.
  5. Apply toothpaste to the toothbrush. Moisten the toothbrush with a small amount of water from the glass. If a toothbrush is unable to be used, moisten a mouth cleaning swab with water or antiseptic mouth wash, depending on the brand of swab used.
  6. If the patient is able, allow them to brush their own teeth. Observe them as they do and offer suggestions if you see that they are neglecting areas (ex: äóìBe sure to get the backs of your teeth.äó).
  7. If the patient is unable to brush their own teeth, ask them to open their mouth. Place the toothbrush at a 45-degree angle to the gum line. Using an up-and-down motion, brush the outer and inner surfaces of all teeth, making sure to include the gum line. Brush the bite surfaces of the teeth with a back-and-forth motion. Lastly, brush the surface of the tongue. Be gentle! An accidental jab with the toothbrush can upset the patient and make them refuse further oral care.
  8. Have the patient rinse their mouth with water and spit into the emesis basin.
  9. The patient should then swish with the alcohol-free antiseptic mouth wash for at least 30 seconds.
  10. Allow the patient to floss their teeth, or do it for them (unless contraindicated). The floss should be gently moved up and down between the teeth. Make sure that none are missed.
  11. Allow the patient to rinse their mouth with water again and spit into the emesis basin.
  12. Help the patient dry their face. Remove the towel from the patient’s chest and clean off the bedside table. Help the patient back to a comfortable position.
  13. Remove gloves and perform hand hygiene.
  14. Record the hygiene procedure per institutional or unit policy. Report any patient complaints of pain or tenderness, or any signs of oral infections such as new odors, lesions, redness or swelling of the gums to the nurse per institutional or unit policy.

Amanda R. McDaniel, MS, BSN, RN

References

Hygiene. (2014). In A. G. Perry, P. A. Potter, and W. R. Ostendorf (Eds), Clinical nursing skills & techniques (8th ed., pp. 405-410). St. Louis, MO: Mosby Elsevier.

More Resources

Caring for a Patient’s Dentures

For patients with dentures, care of the dentures is just as important as brushing natural teeth. Good denture hygiene and fit helps prevent oral irritation and infection.

Axillary Temperature with Electronic Thermometer

Compared to other temperature measurement methods, the axillary measurement is considered the least reliable. An axillary temperature measurement typically reads 0.5 to 1 degree Fahrenheit lower than an oral temperature reading [1]. For this reason, it is recommended to use this method only when other methods are contraindicated or when taking an axillary temperature is the safest method for the patient.

Assisting the Resident to Transfer from the Bed to a Chair or Wheelchair

It is important to remember on which side to place the chair when assisting a patient in transferring. Putting the chair on the resident’s unaffected side allows the resident to lead with his or her strong extremity. This eases the procedure for the resident and reduces the risk of falling.

Perineal Care of the Female Resident

Perineal care should be performed during a bath, after using the bedpan, and/or after incontinence. Proper technique is important for maintaining hygiene, preventing infection, and avoiding skin breakdown. Because of the close proximity between a woman’s urethra, vagina, and anus, it is essential to only wipe in a front to back motion. Wiping in the opposite direction is associated with a greater risk for developing a urinary tract infection.

Collecting a Stool Specimen

Stool specimens are collected to test for a variety of disorders from colon cancer to parasites. While it is not the most pleasant job, it is important that the collection is done correctly for accurate results.

Using a Gait / Transfer Belt to Assist the Resident to Ambulate

Walking (aka, ambulating) helps residents maintain mobility and independence, and prevents complications. However, ambulation must be done safely so that the resident does not have a fall or injury. A gait or transfer belt, when properly used, can increase resident safety. Gait belts can vary between facilities, so make sure you know how to use the one in your facility.

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