Study Guide: Oral care

Topic Outline
1. Definition

2. Purpose of oral care

3. Equipment needed

4. Step by step procedure with rationale

Learning Outcomes
After studying this unit, you will be able to:
1. Understand the benefits of improving oral health.
2.
3.
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4. Familiarize the step by step procedure of oral care 0
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Introduction el
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Good oral hygiene is essential to prevent dental decay and gum disease. With the proper daily use of dental
hygiene tools, a low level of oral bacteria can be easily achieved. This will result in a reduction of bad
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breath, in fewer cavities and in a healthier gum tissue that does not bleed.
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Activating Prior Knowledge a
Did you know that: r
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Definition

Mouth care is defined as the scientific care of the teeth and mouth.

Equipment

1. Tray

2. Gauze-padded tongue depressor: to suppress tongue

3. Torch

4. Appropriate equipment for cleaning:

- Tooth brush,Foam swabs,Gauze-padded tongue depressor,Cotton ball with artery forceps,and dissecting
forceps

5. Oral care agents:

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transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
Toothpaste/ antiseptic solution

❖NURSINGALERT❖ You should consider nursing assessment, hospital policy and doctor’s prescription if there
is, when you select an oral care agent.

6. If you need to prepare an antiseptic solution as an oral care agent:

Gallipot: to make an antiseptic solution, to set up cotton balls after squeezed

7. Cotton ball

8. Kidney tray

9. Mackintosh: small size

10. Middle towel

11. Jug with tap water

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12. Paper bag: for cotton balls, for dirt 0
13. Gauze pieces as required: to apply a lubricant
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14. Lubricants: Vaseline/ Glycerin/ soft white paraffin gel/ lip cream R
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15. Suction catheter with suction apparatus: if available at
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16. Disposable gloves( 1 pair): if available d
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Assisting the client with Oral care a
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PROCEDURE RATIONALE n
1. Explain the procedure Providing information fosters cooperation, understanding g
and participation in care E
2. Collect all instruments required Organization facilitates accurate skill performance

3. Close door and /or put screen To maintain privacy

4. Perform hand hygiene and wear To prevent the spread of infection

disposable gloves if possible

5. If you use solutions such as sodium Solutions must be prepared each time before use to
bicarbonate, prepare solutions required. maximize their efficacy

6. Assist the client a comfortable upright To promote his/her comfort and safety and effectiveness
position or sitting position of the care including oral inspection and assessment

7. 7. Inspect oral cavity

1) Inspect whole the oral cavity ,such as Comprehensive assessment is essential to determine
teeth, gums, mucosa and tongue, with the individual needs.
aid of gauze-padded tongue depressor and
torch

2) Take notes if you find any abnormalities, Some clients with anemia, immunosuppression, diabetes,
e.g., bleeding, swollen, ulcers, sores, etc. renal impairment epilepsy and taking steroids should be

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting 2online, or
transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
 paid attention to oral condition. They may have
complication in oral cavity

8. 8. Place face towel over the client chest To prevent the clothing from wetting and not to give
or on the thigh with mackintosh uncomfortable condition

9. Put kidney tray in hand or assist the To receive disposal surely

client holding a kidney tray

10. Instruct the client to brush teeth Points

of instruction

1) Client places a soft toothbrush at a 45

°angle to the teeth. Effective in dislodging debris and dental plaque from
teeth and gingival margin
2) Client brushes in direction of the tips of
the bristles under the gum line with
toothpaste. Rotate the bristles using
vibrating or jiggling motion until all outer
and inner surfaces of the teeth and gums 1
are clean. 0
Cleansing posterior direction of the tongue may cause the
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3) Client brushes biting surfaces of the gag reflex
teeth 4) Client clean tongue from inner to
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outer and avoid posterior direction. R
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11. If the client cannot tolerate toothbrush When the client is prone to bleeding and/or pain, tooth at
(or cannot be available toothbrush), form brush is not advisable e
swabs or cotton balls can be used d
12. . Rinse oral cavity L
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1) Ask the client to rinse with fresh water To make comfort and not to remain any fluid and debris a
and void contents into the kidney tray. r
2) Advise him/her not to swallow water. If ni
needed, suction equipment is used to To reduce potential for infection and n
remove any excess g
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13. Ask the client to wipe mouth and To make comfort and provide the well-appearance
around it.

14.Confirm the condition of client’s teeth, To moisturize lips and reduce risk for cracking
gums and tongue.Apply lubricant to lips.

15. Rinse and dry tooth brush thoroughly. To prevent the growth of microorganisms
Return the proper place for personal
belongings after drying up.

16. Replace all instruments To prepare equipments for the next procedure

17. Discard dirt properly and safety To maintain standard precautions

18. Remove gloves and wash your hands To prevent the spread of infection

19. Document the care and sign on the Documentation provides ongoing data collection and
records. coordination of care. Giving signature maintains
professional accountability

20. Report any findings to senior staffs To provide continuity of care

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting 3online, or
transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
 Providing oral care for dependent client

PROCEDURE RATIONALE

1. Check client’s identification and condition Providing nursing care for the correct client in the appropriate
way.

2. Explain the purpose and procedure to the Providing information fosters cooperation and understanding
client

3. Perform hand hygiene and wear To prevent the spread of infection.

disposable gloves

4. Prepare equipment:

1) Collect all required equipment and bring Organization facilitates accurate skill performance
the articles to the bedside.
Solutions must be prepared each time before use to maximize 1
2) Prepare sodium bicarbonate solutions in their efficacy 0
gallipot. 3
To reduce potential infection N
❖NursingAlert❖ If the client is unconscious, use plain
tap water.
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3) Soak the cotton ball in sodium Cleaning solutions aids in removing residue on the client’s at
teeth and softening encrusted areas.
bicarbonates solution(3 pinches / 2/3 water e
in gallipot) with artery forceps. d
4) Squeeze all cotton balls excess solution L
To avoid inspiration of the solution e
by artery forceps and dissecting forceps and
put into another gallipot a
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5. Close the curtain or door to the room. Put It maintains the client’s privacy ni
the screen.
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6. Keep the client in a side lying or in a Proper positioning prevents back strain Tilting the head g
comfortable position. downward encourages fluid to drain out of E
7. Place the mackintosh and towel on the The towel and mackintosh protect the client and bed from
neck to chest. soakage.

8. Put the kidney tray over the towel and Put the kidney tray over the towel and mackintosh under the
mackintosh under the chin chin

9. Inspect oral cavity:

1) Inspect the whole oral cavity, such as Comprehensive assessment is essential to determine individual
teeth, gums, mucosa and tongue, with the needs.
aid of gauze-padded tongue depressor and
torch.

2) Take notes if you find any abnormalities, Some clients with anemia, immunosuppression, diabetes, renal
e.g., bleeding, swelling, ulcers, etc. impairment, epilepsy and taking steroids should be paid
attention to oral condition. They may have complication in oral
cavity

Clean oral surfaces:

1) Ask the client to open the mouth and The tong depressor assists in keeping the client’s mouth open.
insert the padded tongue depressor gently As a reflex mechanism, the client may bite your fingers.

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting 4online, or
transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
from the angle of mouth toward the back
molar area. You never use your fingers to
open the client’s mouth.

2) Clean the client’s teeth from incisors to Friction cleanses the teeth.
molars using up and down movements from
gums to crown.
Friction cleanses the teeth.
3) Clean oral cavity from proximal to distal,
outer to inner parts, using a cotton ball for
each stroke.

11. Discard used cotton ball into small To prevent the spread of infection.
kidney tray

12. Clean tongue from inner to outer aspect. Microorganisms collect and grow on the tongue surface and
contribute to bad breath.

13. Rinse oral cavity:

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1) Provide tap water to gargle your mouth To remove debris and make refresh 0
and position the kidney tray.
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2) If the client cannot gargle by him/herself, N
a) rinse the areas using moistened cotton Rinsing or suctioning removes cleaning solution and debris. R
balls or b) insert a rubber tip of irrigating el
syringe into the client’s mouth and rinse at
gently with a small amount of water. e
3) Assist to void the contents into kidney Solution that is forcefully irrigated may cause aspiration To d
tray. If the client cannot spit up, especially avoid aspiration of the solution L
in the case of unconscious client, suction e
any solution a
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14. Confirm the condition of the client's To assess the efficacy of oral care and determine any
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teeth, gums, mucosa and tongue. abnormalities
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15. Wipe mouth and around it. Apply Lubricant prevents lips from drying and cracking. g
lubricant to lips by using foam swab or E
gauze piece with artery forceps

16. Reposition the client in a comfortable To provides for the client’s comfort and safety
position.

17. Replace all equipments in proper place. To prepare equipments for the next care

18. Discard dirt properly and safety To maintain standard precautions

19. Remove gloves and perform hand To prevent the spread of infection
hygiene

20. Document the care and sign on the Documentation provides ongoing data collection and
records. coordination of care. Giving signature maintains professional
accountability

21. Report any findings to the senior staff To provide continuity of care

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting 5online, or
transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
 ❖NursingAlert❖
Oral care for the unconscious clients
1. Special precautions while the procedure
● The client should be positioned in the lateral position with the head turned toward the
side. ( Rationale: It can not only provide for drainage but also prevent accidental
aspiration.)
● Suction apparatus is required. ( Rationale: It prevents aspiration.) To use plain
water for cleaning of oral cavity of unconscious clients may be advisable.( Rationale:
Potential infection may be reduced by using plain water when the solution flows into
the respiratory tract by accident.)
2. Frequency of care Oral care should be performed at least every four hours. ( Rationale:
Four hourly care will reduce the potential for infection from microorganisms.

Interactive Link

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Readings and References
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Brunner & Suddarth’s. Textbook of Medical-Surgical Nursing
WHO intraoperative checklist, Nursing Care Manual and checklist
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All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting 6online, or
transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.