MOUTH CARE

INTRODUCTION:
Mucous membrane continuous with the skin line the oral cavity. Normal mucosa
glistens and pink, soft, moist, smooth and without lesions. Healthy gums fit tightly around
each tooth and appear pink, moist and smooth. Healthy teeth are white, smooth, shiny, and
aligned. The condition of oral cavity reflects overall health. Mouth should be given at least
every morning to all the patients, and preferably after every meal. Routine mouth care is
essentially assisting a patient to brush his teeth, and rinse his mouth thoroughly, as often as
needed.

Definition
“Oral hygiene is defined as cleaning the teeth and the oral cavity of the patient. It includes
the measures to prevent the spread of disease from mouth and increase the comfort of the
patient.”
•Maintaining cleanliness of the oral cavity is known as the oral hygiene.
 Assisting in cleansing the patient teeth and oral cavity by mechanical brushing and
rinsing is termed as mouth care.
 Cleansing the patient teeth and oral cavity using an antiseptic solution is termed as
mouth wash

Aim
To maintain the healthy state of oral cavity including mouth, gums, teeth and lips.

Purposes
 Maintains the healthy state of mouth, gums, teeth and lips.
 Removes food particles from and between the teeth.
 Stimulates appetite.
 Provides a sense of well-being.
 Removes dental plaque. or to prevents dental caries
 Prevents sores and infection of the oral tissues.
 Relieves discomfort resulting from halitosis and taste.
 Prevents gum inflammation and infection.
 Prevents the mucous membrane from becoming dry.
 Prevents sores, which results in ulceration.
 Maintains the intactness and health of the lips and oral cavity.
 Prevents oral infections.
 Cleans and moisten the membranes of the mouth and lips.
 Stimulates the circulation to the gums.
Indications
 Seriously ill patient.
 Patients with fever.
 Postoperative patients.
 Unconscious patients.
 Patients breathing through mouth.
 Paralyzed patients.
 Patients with infections and disease of mouth.
 Patients under anesthesia

Preliminary assessment
A. Check the condition of the oral cavity
Physical features Observe for
Teeth or dentures Plaques, debris, or dental caries, ill
fitting dentures
Mucus membrane Coating, redness, ulceration, or
bleeding
Tongue Coating, bleeding, cracking, any
blisters, or areas of redness
Lips Cracking, bleeding, ulcerations
Saliva Consistency and quality
Gums Redness, ulcerations and bleeding

B. check the ability of the patient for selfcare.

C. Check the general condition of the patient.
D. The frequency of mouth care needed.
E. Doctor’s orders for specific precautions regarding the movement, positioning
of the patient and use of any specific solutions.
F. Articles availability in patient unit.
 Articles (for routine mouth care)
A clean tray containing…
S. ARTICLE RATIONALE
NO
1 Disposable gloves To protect self and others.

2 Small mackintosh To protect the bed and garments

3 Face towel For wiping face in between and after procedure.

4 Small jugs 2 To take warm and cold water for mouth wash

5 Feeding cup 1 Facilitates to pour water into the mouth in lying

down position
6 Emollients To soothe or soften the mucus membrane,
particularly when lips are dry and cracked.

7 Dentifrice and soft To clean teeth and tongue.

bristle tooth brush.

8 Cotton applicators To apply emollients

9 Chlorhexidine To enhance freshness and removes bed odours

solution
10 Kidney tray with To collect used water and used swabs
paper bag

11 Small tub To receive used water

Articles (special mouth care)
A clean tray containing:

s.no Articles Rationale

1 Disposable clean gloves or To protect self and others.
sterile gloves
2 Small mackintosh To protect the bed and garments
3 Face towel For wiping face in between and after procedure.
4 Small bowl To take antiseptic solutions (mouth wash solution).

5 Artery forceps 1 To hold gauze piece and cotton balls.

6 Dissecting forceps 1 To remove dead cells and debris.
7 Gauze pieces To clean mouth of patients who an unable to clean
themselves. (to clean coated tongue and teeth).
8 Kidney tray To receive the used water.
9 Paper bag 1 To receive used swabs.
10
To brushing teeth and oral cavity
11 Dentures brush To clean the dentures
12 Mouth wash solutions To enhances freshness and to remove bad odours.
13 Emollients To soothe or soften the mucus membrane,
particularly when lips are dry and cracked
14 Cotton applicators To apply the emollients
15 Tongue depressor To keep the mouth opened when the patient is
unconscious or unable to do him self
16 A bowl with clean water To receive dentures if any

Dentifrice commonly used:

Reliable tooth paste or tooth powder with a soft brush.
Glycerine with lime juice
Sodium bicarbonate paste.
Equal parts of sodium chloride, sodium bicarbonate, and calcium carbonate
Neem stick.
Solutions commonly used
Potassium permanganate (KMNO4) 1:5000
Hydrogen peroxide (H2 O2) 1:8.
Sodium chloride
Number of commercial solutions available in market.
Emollients used
Cream or butter
White Vaseline
Liquid paraffin
Glycerine borax
Olive oil

Preparation of the patient and unit

(or)
Instructions before procedures

S.NO INSTRUCTIONS RATIONALE

1 Explain procedure to the patient (if conscious) To gain knowledge and

confidence about procedure.
2 Provide privacy or screen To gain co-operation and to
maintain self respect of the
patient.
3 Maintain safe and comfortable position for the To provide comfort for the
patient. Place the patient in sitting position or in a client and saves the time.
fowlers position with the cardiac table in front.
Arrange all articles in cardiac table and assist him
as needed.
4 If the patient is contraindicated for the elevated It minimize the aspiration
position, place him left lateral position with his into the lungs and give easy
face at edge of the pillow and nurse stands at left to do procedure.
side of the patient to help him. In a left lateral
position patient can brush his teeth by using his
right hand .
5 If the patient is unconscious or completely helpless It enhances procedure easy
turn him to the right side and the nurse stands at to the nurse when client is
right side of patient to do the procedure. The side unconscious.
lying position will allow if any secretions present in
the mouth it will comes out from the corner of
 mouth.

6 Place the mackintosh and face towel across To protect clothing and bed
the chest. linen.
7 7. Place the kidney tray close to the cheek Concave shape of the
with the concave side towards the patient or allow kidney tray can easily place
the patient to adjust the kidney tray according to close the cheek of the
him convenience. patient to collect waste
water without fall of water
on bed.
8 Arrange the all articles in conveniently to avoid To save time.
over reaching

PROCUDURE
Mouth care of a patient who is able to care himself ( routine mouth care)
S.N STEPS OF PROCEDURE RATIONALE
O
1 Wash hands and wear a clean-disposable To prevents cross infections
gloves
Spread face towel under the skin To prevents soiling of the bed linen
and clothing.
2 Mouth wash with potassium KMNO4 acts as a antiseptic and
permanganate solution( or chlorhexidine deodorant
solution) with adding of warm or cold
water, or normal saline or normal water
also we can use.
3 Help the patient to rinse his mouth Makes the mucus membrane moist and
Let the patient hold the kidney tray prevents tissue trauma during the
according to his convenience to return brushing
flow of water
4 Pick the tooth brush, wet it with water Wetting the brush helps to bristles soft
spread the small quantity of tooth paste and prevents tissue injury
on it and hand over to the patient
5 Instruct the patients to brush the teeth in Ensure thorough cleaning of all the
all sides outer sides, inner sides, left and areas of tooth and mouth.
right sides and also tell the patents to
clean the enamel and gums.
6 After finishing of brushing, pour water Immediate washing of the brush
on brush and holding over it in a kidney ensures the thorough cleaning and
tray, clean thoroughly and put back the easier to t use next time
brush.
7 Help the patients to rinse his mouth Thorough rinsing helps thorough
 thoroughly
8 Ask the patient to massage his gums by
placing the thumb and index finger over
the ridges of gum using a press and
release motion. Help the patients wash
face and hands. Wipe with a towel.
9 Ask the patient to apply emollients to the
lips and mucus membrane
10 Make a comfortable position to the
patient
11 Remove all articles from the bed side
cleaning
Massaging the gums stimulate the
circulation, tightens the oral mucosa,
and increases resistance to the tissue
trauma.
To prevent drying
To provide comfort and feel of ease.
To keep bed side clean.

Mouth care of a patient who is not able to care for himself (an unconscious
patient), special mouth care procedure:
S.NO STEPS RATIONALE
1 Wash hands and wear clean To prevent cross infection.
disposable gloves
2 Spread mackintosh and face towel To prevents soiling of bed linen and clothing
under the head or across the chest
under the chin
3 Wash mouth with potassium KMNO4 acts as a antiseptic and deodorant
permanganate solution prepared
with warm or cold water
4 Make a paste with soda bicarb or To clean the teeth
salt or use any dentifrice which is
available
5 Place the kidney tray close to the To collect the saliva or water from the mouth
cheek. that may dribble from the mouth and protect
bed linen.
6 Do not pour water into the mouth To prevent aspiration of fluids into the lungs
if the patient is unconscious. because of poor gag reflex.
7 Take a small bowl and pour Excessive fluid may cause aspiration of fluid
antiseptic solution in it, With into the lungs.
mouth gag in position , clean the
tongue, with using gauze covered
artery forceps. Wet the gauze only
with small amount of solution.
8 Moistens the gauze and dip it in a Ensure thorough cleaning and prevents injury
 cleaning agent, swab each teeth of oral mucosa and gums.
with gently but firmly, taking care
of all sides of teeth
9 Take a gauze wrap it around the The cotton boll being slippery after wet.
forceps, covering the tips The gauze piece acts better.
completely & clean the coated
tongue & teeth.
10 Thorough cleaning of teeth and
tongue is ensured by repeating To provide complete mouth and care of oral
each stroke, use a separate gauze cavity.
for each stroke, continue the
procedure up to the cleaning of
oral cavity then stops and wipe
the face with towel.
11 Apply emollients to the lips and
mucus membrane To prevents drying
12 Remove the kidney tray,
mackintosh and towel
13. Make the patient comfortable and
tide up the unit
14 If there is collection of secretion To enhance air way clearance.
in the mouth apply suction.
15 Wash your hands To prevent cross infection.

After care of the patient and articles

1. Take all articles to the utility room. Discard the wastes and clean the articles with
soap and water. replace the them in their proper places. Personal articles replace into
the bed side table.
2. Care of dentures (artificial teeth)
Dentures can be brush at the sink under running water. While cleaning the
dentures grasp it in the palm of the one hand and brush with other hand. Encourage
the patient to wear the dentures during the day. This will improve the eating
technique, speech, appearance and contour of the mouth.
For a seriously ill or patients who are under anaesthesia or an unconscious patients the
dentures are removed for fear of dislodging the dentures and blocking the respiratory
passage. When the dentures are removed from the patients mouth, they should be
stored in labelled container to prevents loss and breakage.
 Ideally dentures are cleaned after each meal. For the case of re insertion dentures are
rinsed in cold water, remember that hot water may distort the dentures.
3. Wash your hands.

Documentation
Document the procedure for communication to the team members with the date, time,
solutions used, condition of oral cavity, response after procedure and observe abnormalities.

Summary
At end of the seminar the students can able to gain the knowledge regarding
about complete procedure of mouth care that including introduction, definition, aims,
purposes, indications of patients, preliminary assessment, complications of neglected mouth
care, articles with rationale and dentifrice, solutions, emollients commonly used, instructions
before procedure, procedure with rationale, after care of the articles and patient and also
documentation of procedure.
Bibliography

Sr Nancy : principles and practices of nursing

7th edition
Vol.1
N.R.P publishing house
( p.g no: 181 – 187)