ORAL HYGIENE FOR CONSCIOUS PATIENT

1. Assessment: Verify extent of client’s ability to brush his teeth. Inspect

lips, gums, and oral mucosa for deviation from normal. Evaluate
presence of oral problems such as dental caries, halitosis, or gingivitis
or loose or broken teeth.
2. Preparation: assemble equipment and place at bedside table.
3. Explain to the client what you are going to do, why it is necessary, and
how she can cooperate.
4. Wash hands and observe other appropriate infection control procedures
like putting on gloves.
5. Assist client to a sitting or Fowler’s position if the client’s condition
allows. If not, assist client to a side-lying position with head turned to
side.
6. Place the towel under the client’s chin tucking it behind the shoulders.
7. Moisten the bristles of the toothbrush with tepid water and apply the
toothpaste to the toothbrush
8. If client is able to brush his teeth, hand the toothbrush to him. If not,
proceed to the next step.
9. Hold the brush against the teeth with the bristle at a 45-degree angle.
The tips of the outer bristles should rest against and penetrate under the
gingival. Gently move the bristle up and down. Repeat until all outer
and inner surfaces of the teeth and suici of gums are cleaned. If tongue
is coated, brush gently with the toothbrush.
10. Hand the client the water cup or mouthwash to rinse the mouth
vigorously or assist client when necessary. Then ask the client to spit
the water and excess toothpaste into the emesis basin. Repeat until the
mouth is free of toothpaste and food particles.
11. If available, floss the teeth or assist the client to floss
independently. Help the client in wiping the mouth after gargling.
12. Remove and discard gloves. Dispose of equipment appropriately
according to agency policy
13. Document procedure performed including assessment of the
teeth, gums, tongue and oral mucosa.

ORAL HYGIENE FOR UNCONSCIOUS PATIENT

1. Assess for presence of gag reflex. Position patient in sim’s or
side-lying position with head turned well toward dependent
side.
2. Explain procedure to patient.
3. Wash hands and apply disposal gloves.
4. Place paper towels on over bed table and arrange equipment.
Turn on suction machine and connect tubing to suction
catheter.
5. Pull curtain around bed or close room door.
6. Raise bed to highest horizontal level; lower side rail.
7. Bring patient close to side of bed and near you, be sure
patient’s head is turned toward mattress.
8. Place towel under patient’s face and emesis basin under chin.
9. Carefully retract patient’s upper and lower teeth with padded
tongue blade by inserting blade quickly but gently between the
back molars. Insert when client is relaxed, if possible.

10. Clean mouth using brush or tongue blade moistened with

peroxide and water. Have second nurse suction as secretions
accumulate during cleansing. Clean chewing and inner tooth
surfaces first. Clean outer tooth surfaces. Swab roof of mouth
and inside cheeks. Gently swab or brush tongue but avoid
stimulating gag reflex (if present). Moisten clean swab or
toothbrush with water to rinse. Repeat rinse several times.
Suction any remaining secretions.
11. Apply thin layer of petroleum jelly to lips.
12. Explain that procedure is completed.
13. Remove gloves and dispose in proper receptacle.
14. Reposition patient comfortably, raise side rail, and return
bed to original position.