I.  Assessment includes the physical exam, consideration of developmental changes), assessment of hygiene preferences and practices, and assessment of risk factors for oral problems.

  1. Types of clients that have risk factors for oral problems:
  2. Paralyzed clients or clients that have restrictions to the upper extremities (i.e. casts)
  3. Unconscious, confused, combative or depressed
  4. On fluid restrictions, or have NG (nasogastric) tubes, O2, or Mouth breathers. (all these things dry the mouth)
  5. Clients undergoing radiation- this causes soreness, dysphagia, dryness, and taste changes.
  6. Receiving chemotherapeutic drugs- these cause ulcers in the mouth and inflammation of the mucosa.
  7. Oral surgery, mouth trauma, or airway tubes

II.  Nursing Diagnosis related to oral hygiene problems

  1. Altered Oral Mucous Membranes
  2. Pain
  3. Altered Nutrition, Less Than Body Requirements
  4. Self-Care Deficit
  5. Body Image Disturbance r/t Dentures, absence of teeth, or halitosis
  6. Knowledge Deficit about oral hygiene

III.  Common Oral Problems

  1. Dental Caries (cavities)
  2. Periodontal disease (this is a long term process involving infection and destruction of the supporting structures of the teeth)
  3. Stomatitis- an inflammatory condition of the mouth results from contact with irritants (tobacco), vitamin deficiency, use of chemotherapy.
  4. Glossitis- Inflammation of the tongue
  5. Gingivitis- Inflammation of the gums
  6. Oral Malignancy- Most common site is the base of the tongue (might see lumps or ulcers)

IV.  Goals for planning care include maintaining healthy mucosa, preventing infection and dental caries, promoting an understanding of oral hygiene and practices, and promoting self esteem and comfort.

V.  Implementation

  1. Brushing of teeth
  2. Within 30 minutes of eating carbohydrates or sweets to reduce the action of plaque
  3. Brush should be small enough to reach all areas of the mouth, brush inner, outer, and all chewing surfaces.
  4. Unconscious client- assess for presence of gag reflex- place in side-lying position. Have a suction machine available.
  5. Oral care sponges are used for the client who is unable to tolerate brushing because of oral trauma or bleeding tendencies
  6. Do client teaching:
  7. Do not share toothbrush
  8. Do not drink directly from the bottle of mouthwash
  9. Include info on how often to brush, when to brush, and type of toothbrush and toothpaste to use.
  10. Fluoride toothpaste is preferred but excessive fluoridation can result in discoloration of tooth enamel.
  11. Flossing is necessary for effective removal of plaque and tartar between the teeth. Flossing once a day is sufficient.
  12. Lemon- glycerin swabs- Although theses have been use widely in the past they can have harmful effects on the teeth and mucosa- Glycerin has an astringent effect, drying mucous membranes and also provides nourishment for bacteria and the lemon can erode the enamel. There is a liquid saliva also available to help keep mucous membranes moist.
  13. Special oral hygienic measure can include the use of equal parts of H2O and H2O2 to cleanse the mouth. Sordes- This is a condition when foul matter collects on the lips and teeth in low fevers, consisting of food, microorganisms and epithelial elements. It is removed with equal parts of Cepacol mouthwash and H2O2.
  14. Denture Care- Clients should be encouraged to clean their own dentures as frequently as natural teeth. After dentures are removed for cleaning inspect the mouth for any abnormalities. Brush their mouth with a soft toothbrush gently, rinse and reinsert the dentures. Always wear gloves for all mouth care.