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Lecture 11

NSE 12A/B Lecture Notes - Lecture 11: Dental Plaque, Tooth Brushing, Mouth


Department
Nursing
Course Code
NSE 12A/B
Professor
Jennifer Menezes
Lecture
11

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NSE 12
Week 11- Nursing Interventions
Oral Hygiene
Discuss the role that the nursing process and critical thinking play in the provision of oral
hygiene
Anatomy and Physiology
Oral cavity extends from the lips to the anterior pillars of the tonsils
Responsible for taste, mastification, speech
Buccal mucosa is light pink and moist
Floor mouth, under tongue is supplied with blood vessels which allow for rapid
absorption of sublingual medications
Three pairs of salivary glands that release enzymes, protect mucosa from heat and
chemicals, transmit taste information, provide lubrication for movement of food
32 permanent teeth, each has a crown, neck and root
Consequences
Patients who do not have regular oral hygiene may have receding gum tissue, gingivitis,
coated tongue, discoloured teeth and halitosis (bad breath)
Can also have localised pain and infection from periodontal disease and tooth disorders
Importance in acute setting
Identification of risks for infection can suggest type and frequency of oral care
Can decrease risk of aspiration and nosocomial infections in ventilated patients
Gram-negative bacteria in dental plaque has been linked to pneumonia in older adults
Oral Hygiene
Maintain healthy state of mouth teeth, gums, lips and tongue
Brushing cleans the teeth of food particles, plaque, and bacteria
It also massages the gums and relieves any discomfort from odors and tastes
Flossing further remove plaque and bacteria from between teeth and reduce gum
inflammation and infection
Patients shouldn’t have food that promote plaque formation and tooth decay such as
carbonated beverages, breads, and starches
Oral hygiene immediately after a meal further reduces plaque
Patients should have a dental checkup every 6 months
Care Plans
Social and cultural situations
Recommendations, supplies, care barriers
Describe components of inspection and assessment of the oral cavity that a nurse performs
as part of the provision of oral hygiene.
Inspection
Inspect all areas of the oral cavity for colour, hydration, texture and lesions
Assessment
Assess patient’s eating patterns before providing oral care. Ask if they have problems
with chewing, swallowing or the fit of their dentures
Providing care

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NSE 12
Patients should brush four times a day with a toothbrush with soft, rounded bristles
- Should be replaced every three months
Flossing should be done once a day
- Patients who are receiving chemotherapy or radiation should use unwaxed floss
Patient who are unconscious should receive care every two hours
Providing Care
1. Determine patient’s oral hygiene practices
a) Frequency of tooth brushing and flossing
b) Type of toothpaste or dentifrice used
c) Last dental visit
d) Type of mouthwash or moistening preparation such as over-the-counter, saliva
substitutes or sugar-free gum with xylitol
2. Access risk for oral hygiene problems
3. Access patient’s risk for aspiration: impaired swallowing, reduced gag reflex
4. Access patient’s ability to grasp and manipulate a toothbrush. (For older adults, try a 30
second tooth brush assessment)
5. Prepare equipment at bedside
6. Perform hand hygiene and put on disposable gloves
7. Inspect the integrity of the lips, teeth, buccal mucosa, gums, palate, and tongue
8. Identify the presence of common oral problems:
a) Dental caries-chalky white discolouration of a tooth or the presence of brown or black
discolouration
b) Gingivitis- inflammation of the gums
c) Periodontitis- receding gum lines, inflammation, gap between teeth
d) Halitosis- bad breath
e) Cheilosis-cracking of the lips
f) Stomatitis- inflammation of the oral tissue
g) Dry, cracked, coated tongue
9. Explain the procedure to the patient and discuss preferences regarding the use of hygiene
aids
10. Raised the bed to a comfortable working position. Raise head of the bed to. (If patient
condition allows) and lower the side rail. Move the patient, or help patient move closer. A
side-laying position can be used.
11. Place paper towels on an overbed table, and arrange other equipment within easy reach.
12. Place towel over patient’s chest
13. Apply toothpaste to brush, holding over the emesis basin. Pour a small amount of water
over toothpaste.
14. Patient may assist by brushing. Hold toothbrush bristles at 45-degree angle to the gum
line. Be sure that bristles rest against and penetrate under gum line. Brush inner and outer
surfaces of upper and lower teeth by brushing from gum to crown of each tooth. Clean
biting surfaces of teeth by holding top of bristles parallel with teeth and brushing gently
back and forth. Brush sides of teeth by moving bristles back and forth.
15. Have patient hold brush at 45-degree angle and lightly brush over surface and sides of
tongue. Avoid initiating gag reflex.
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NSE 12
16. Allow patient to rinse mouth thoroughly by taking several sips of water, swishing water
across all tooth surfaces, and spitting in the emesis basin.
17. Allow patient to gargle and rinse mouth with mouthwash if desired.
18. Assist in wiping the patient’s mouth.
19. Allow patient to floss.
20. Allow patient to rinse mouth thoroughly with cool water and spit in emesis basin. Assist in
wiping patient’s mouth.
21. Ask patient whether any area of oral cavity feels uncomfortable or irritated. Inspect the
oral cavity.
22. Assist patient t comfortable position, remove emesis basin and bedside table, raise side
rail, and lower bed to original position.
23. Wipe off overbed table, discard any soiled linen and paper towels in appropriate
containers, remove soiled gloves, and return equipment to the proper place.
24. Remove gloves and perform hand hygiene
25. Ask patient to describe proper hygiene techniques
Describe conditions that place clients at risk for oral hygiene problems and discuss their
related implications and interventions:
Diabetes, physical disabilities involving hand grasp or strength affecting the ability to
perform oral care, lack of attention to oral care and prescribed medications that affect the
buccal (oral) mucosa
Aging teeth become brittle, drier and darker
- Teeth can become uneven, jagged and fractured
- Gums lose vascularity and tissue elasticity which can cause dentures to fit poorly
Radiation and chemotherapy reduce saliva production, resulting in dryness and stomatitis
(inflammation of the oral mucosal tissue)
- Can destroy normal flora in the mouth allowing for the overgrowth of opportunistic
bacteria
- Oral examination should be more throughout and detailed, involving all surfaces of
the tongue and mucosa
Xerostomia (dry mouth) is common in older adults, chemotherapy, those with medical
conditions and as a side effect of certain medications
-Can apply non petroleum on oral tissue every two hours
-Toothpaste and mouth wash meant for dry mouth (pea-sized amount)
-Ultra-soft brush should be used, moisten with water
-Glycerine swabs, hydrogen peroxide, hard toothbrushes, spicy food, alcohol-based
mouthwash should be avoided
-Rinsing mouth with soda water or saline
-Lubrication of dentures
-Sugar free items (mints, gums, candy) can be used
-Low sugar diet, water intake
Mucositis is a painful inflammation and ulceration of the mucous membranes lining the
digestive tractis and it is a complication of cancer therapy
-Weight loss; affect ability to sleep, eat, talk; increased infection
-Clean, moist oral cavity
-Club soda (right pH) can be used
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