Personal hygiene: Oral care

Now, oral hygiene is essential to prevent mouth infections and bad breath. To maintain proper oral hygiene, you have to remember three basic steps: brushing, flossing, and rinsing.

The frequency of oral hygiene depends on the individual's condition and comfort level, but it’s typically performed in the morning, after meals, and before bed.

Clients who are unable to take food and fluids by mouth, like those who are unconscious, will require oral hygiene every 1 or 2 hours to keep their mouths fresh.

Before we continue, there are several important definitions that you should know. Halitosis refers to a chronic bad breath which can be the result of poor oral hygiene or an underlying health problem.

Dental plaques are films of saliva and microbes that stick to the teeth and can lead to tartar which are crusty deposits.

Dental caries, also known as tooth decay or cavities, is damage caused by acid-producing bacteria in the mouth. Stomatitis refers to any inflammation that affects mucous membranes of the mouth and lips.

Next up is gingivitis which is non-destructive inflammation of the gingiva, or gums. If left untreated, gingivitis can lead to periodontitis which is a severe inflammation of the supporting structures of teeth, including soft tissue and bones.

Moreover, in people over the age of 35, periodontitis is the main cause of tooth loss. If a person has lost a tooth, they can replace it with a prosthetic tooth which is also known as a dental implant.

On the other hand, dentures are removable replacements of the missing teeth and surrounding tissue which allow people to chew food normally. When a person has no natural teeth left, it’s called edentulous.

Before you start with the procedure, review the client's medical record and evaluate possible oral hygiene issues.

These include: restriction of food and water which can cause mucosal dryness; presence of tubes, such as endotracheal, nasogastric, or oxygen tubes which can lead to irritation of mucosa; and previous mouth surgeries which are associated with increased risk of infection and bleeding.

Additionally, check if your client is on chemotherapeutic medications or antibiotics because those medications can alter the normal flora of the oral cavity and subsequently cause infection or inflammation.

Also, radiation therapy can reduce salivary flow and lower salivary pH. Eventually, this can lead to tooth decay and stomatitis.

Finally, don’t forget to check for conditions that are associated with inflammation of gums such as diabetes mellitus.

Now, to perform oral hygiene you must have clean gloves, cups, paper and bath towels, an emesis basin, mouthwash, lubricant for lips, dental floss, toothpaste, and toothbrush with soft bristles.

If brushing is contraindicated, use an oral swab instead of a toothbrush. Prepare your working area by covering the overbed table with paper towels and placing your equipment

Raise the bed and head of the bed to a comfortable working position that’s tolerated by the client. Typically, the head of the bed should be in a semi-Fowler’s or Fowler’s position to prevent aspiration.

Lower the side rails on the side of the bed that you are standing, and place a towel under the client’s chin to protect their clothing.

Remember to encourage the client to do as much of the procedure independently as they possibly can.

To brush and floss the teeth, start by moistening the toothbrush with water then apply the toothpaste. Clean the teeth by holding the toothbrush at a 45 degree angle to the teeth.

This way, bristles can slide under the gum line and clean the surface where plaques accumulate.

Start by brushing the outer surfaces of the teeth, then focus on the inner surfaces, and finally, clean the surfaces used to chew food.

Always start at the back of the mouth and proceed to the front with a gentle circular motion. During the process, allow the client to rinse their mouth with water as needed.

Hold the emesis basin in front of them, so they can spit the water without changing their position. Finally, brush the tongue while avoiding the back of the tongue since stimulating this area can cause the gag reflex.

Let the client rinse their mouth with antiseptic mouthwash. Help them dry the area around the mouth, and proceed with flossing (unless it’s contraindicated).

Wrap the dental floss around the middle fingers of each hand, and hold the ends between your index finger and thumb. Floss each tooth separately by using up-and-down motions.

Once done, have the client rinse their mouth with water. Offer to help the client put on lip balm or lubricant if they desire.

Alright, let’s move on to cleaning dentures. Besides basic bedside supplies, you’ll also need a 4x4 inches of gauze, denture cup, denture adhesive, and a washcloth.

First, ask the person to remove their dentures. You might need to help if the client can’t do this on their own.

To remove the upper denture, use gauze to grasp the front teeth with your thumb and index finger, and gently pull downward.