PROCEDURE CHECKLIST

ORAL CARE

NAME OF THE STUDENT:

SL. PERFORMED
NO TASKS REMARKS
. YES NO

1. Assess the client’s ability to brush her/his teeth.

Gathers equipment. Place on an overbed table or patient’s
2.
table.
3. Do handwashing.

4. Provide privacy for the patient.

5. Position patient in Semi-fowler’s position.

Place a towel under the patient’s chin, tucking it behind the
6.
shoulder.
7. Let patient sip water and gargle.
Hold the toothbrush over the emesis basin, pour a small
8. amount of water over it and apply toothpaste.

Ask patient to place toothbrush at 45 degrees angle to

9. gumline and brush from gumline to crown of each tooth.

10. Brush back and forth across biting surfaces of each tooth.

11. Brush tongue gently with toothbrush.

Allow the client rinse mouth with several sips of water and
12. spit onto emesis basin.

13. Offer mouth wash or dental floss if available.

14. Help the client wipe the mouth.

15. Remove equipment used. Do aftercare.

16. Discard waste in proper bin.

17. Place the patient in comfortable position.

SL. TASKS PERFORMED REMARKS
NO YES NO
.

18. Do handwashing.

Document the procedure. Record time procedure is done,

19. findings related to condition of mouth and gums.

20. Report significant findings to seniors or physician.

TOTAL

NOTE:
YES-1
NO-0

SCORING:
0-7: POOR
8-13: FAIR
14-17: GOOD
18-20: EXCELLENT

_____________________________ ________________________________
Signature of the Performer with date Signature of the Evaluator with date