Oral Care Procedures

Here is a pdf copy of the following information: Oral Care Procedures. Non-commercial “fair use” is permitted (i.e., copying for facility or patient use). Otherwise, may be used with permission.

Oral Care Procedures for the Dependent Patient

© 2014 Karen Sheffler of SwallowStudy.com

Perform every shift (before/after meals as needed)

Oral Care Tools:

Toothbrush (on suction if available), swabs (on suction if available), extra toothettes/swabs to apply mouthwash and moisturizer, Yankauer-oral suction, mouthwash, oral moisturizer, water-based lip moisturizer, gloves, and Chlorhexidine* measured out in medicine cup if prescribed by doctor.

  1. Sit the patient fully upright or in an elevated side-lying position to prevent aspiration during mouth cleaning.

  2. Inspect the patient’s mouth:

  • Check lips, teeth, gums, inside cheeks, tongue, and mucosa of floor and roof of mouth.
  • Note any food, coating, bleeding, dryness, edema, redness, or other debris.
  • Note degree of saliva pooling (excessive secretions?).
  1. Remove loose material or debris (especially important if patient is NPO/Nothing by Mouth):

  • Use Yankauer suction to remove excessive secretions and loose debris.

  • Use Suction Swab (or toothette if Suction Swab not available) to remove as much debris as possible.

  • Scrub tongue, gums, and entire roof of mouth.

  • Use Perox-A-Mint Solution (1.5% Hydrogen Peroxide) on the swabs if mechanical action is needed to assist in debridement. Avoid Hydrogen Peroxide if oral thrush and/or oral lesions. Instead try a baking soda solution: 1 tsp of baking soda in 8 oz of water (this does not replace prescribed treatment for the thrush).

  1. Brush the teeth with toothpaste. A Suction Toothbrush is best if risk for aspiration and significant debris; otherwise an electric toothbrush is more thorough than a regular brush. If the above are not available, use a soft toothbrush and a separate oral suction.

  • If dentures, remove, gently brush and rinse. Soak dentures overnight.

  • Gently brush teeth in circular motions at a 45 degree angle to the gum line.

  • Brush for 1-2 minutes to remove plaque build-up.

  • Some bleeding is okay, unless contraindicated (i.e., low platelet count/bleeding risk). Mild bleeding indicates the need for consistent and improved oral care.

  • Brush the tongue.

  1. Rinse the mouth with Suction Swab or clean-moist toothette & Yankauer suction.

  2. Mouthwash*: dip toothette into a standard oral rinse. Most mouthwashes at the hospital contain 0.05% Cetylpyridinium Chloride (anti-fungal and anti-bacterial) to reduce the risk of infection and to remove plaque.

  • Swab along teeth, gums, tongue, roof of mouth.

  • Suction to remove excess.

  1. Mouth and lip moisturizer: apply moisturizer inside the mouth with a toothette (e.g., artificial saliva substitute, like Biotene or a Mouth Moisturizer from SAGE kits). Apply water-based moisturizer to lips with gloved finger (avoid petrolatum-based products, as these do not penetrate and heal tissue).

—done—

8. *If indicated and prescribed, use 0.12% Chlorhexidine Gluconate (CHG): for treatment of gingivitis (i.e., redness, swelling and bleeding of gums), for a strong anti-microbial, if the patient is intubated, and to reduce pneumonia risk.

      • Apply after breakfast and before bed, after oral care steps #1-5.

      • DO NOT use mouth moisturizer in step #7 if CHG indicated. Apply mouth moisturizer at another time in the day as needed.

      • DO NOT rinse mouth, eat or drink for 30 minutes after using CHG.

      • DO NOT swallow: Swab around mouth completely and suction excess.

 

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