Nursing & Healthcare Programs

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

Prone Position

Prone position is not used as commonly as other patient positions. This position allows for full extension of the hips and the knees and gives many bony prominences a break from continuous pressure. However, placing patients in prone position does not come without the risks of pressure ulcers.

Passive Range of Motion Exercises

Range of motion exercises are used to help prevent or decrease contractures, improve flexibility of joints, and improve strength [1]. Bedridden patients as well as those with reduced mobility may greatly benefit from passive range of motion exercises. However, do not perform these exercises without an order to do so, as it may be contraindicated in certain situations.

Measuring and Recording Output from a Urinary Drainage Bag

Accurate measurement of urination (aka, the output portion of intake and output) allows medical personnel to assess kidney and bladder function. Changes in output quantity or quality can reflect health status changes including new-onset infection or renal injury.

Logrolling the Resident

Logrolling is a technique used to roll a resident onto their side without the resident helping, and while keeping the resident’s spine in a straight line. This is especially important for residents who have had spinal surgery or injury.

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.

Offering the Bedpan

When a resident is bed-bound, they must use a bedpan to urinate and defecate. This can be embarrassing for the resident, so it should be done with sensitivity to the resident’s privacy and dignity. There are two types of bedpans. A regular bedpan is the deeper and more rounded of the two. A fracture pan has a relatively flat upper end with a trough at the lower end. Fracture pans are used for residents who have difficulty, or restrictions against, moving their hips and/or backs.