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

Moving the Resident to the Side of the Bed

Residents are usually kept in the center of the bed for safety reasons. However, moving a resident to the side of the bed is an important step to take before turning a resident onto his or her side. Performing this action allows the resident to end up side lying in the center of the bed and not smashed up against the side rail.

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.

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.

Performing the Heimlich Maneuver

The Heimlich Maneuver, also known as abdominal thrusts, is used to remove an object that is blocking a resident’s airway and preventing air from reaching the lungs. It only takes four to six minutes for brain damage to occur from lack of oxygen, so prompt action is vital.

Dressing and Undressing a Patient

Patients who have suffered a stroke or have weakness or injury to one side of their body may struggle with dressing and undressing. In order to help these patients regain their strength and independence, it is important that the nurse’s aide only assist them as needed. The nurse’s aide may need to teach patients how to dress and undress safely with their limitations.

Removing Personal Protective Equipment

It is important to follow the correct procedure while removing personal protective equipment to avoid contaminating your skin or clothing. The most common source of contamination in this process stems from improper removal of gloves. Gloves are often the most soiled piece of equipment. To avoid contaminating your skin or the other equipment worn, gloves should always be removed first. Then remove the goggles, gown, and mask, in that order.