Pamantasan NG Lungsod NG Maynila

PAMANTASAN NG LUNGSOD NG MAYNILA
(University of the City of Manila)

General Luna Street comer Muralla Street
Intramuros, Manila
COLLEGE OF NURSING
(Dalubhasaan ng Narsing)
BACON – SKILLS LABORATORY CHECKLIST #

Hygiene: Oral Care
Name: ________________________ Date: __________

Year Level and Block: ___________ Clinical Instructor: ___________
Providing Oral Care: Brushing the Client’s Teeth

PURPOSES
 To remove food particles from around and between the teeth
 To remove dental plaque, reduces the risk of cavities and mouth disease
 To promote the client’s feelings of well-being, improves appearance and self-esteem
 To prevent sores and infection of the oral tissues
 Stimulates circulation to oral tissues, tongue, and gums
 Decreases microorganisms in mouth and on teeth
 Decreases build-up of food residue on teeth
 Improves appetite and taste of food
Equipment
 Soft toothbrush
 Toothpaste
 Toothettes or swabs
 Emesis basin
 Non sterile gloves
 Towel or linen saver and washcloth
 Cup of water
 Mouthwah (alcohol free)
 Dental floss (optional)
 Petroleum jelly or mineral oil
 Suction and catheter (if client is unconscious)
 Pen
PLM-CN (NRS 1204 – Basic Concept in Nursing – SKILLS Laboratory Checklist on Hygiene: Oral Care
ASSESSMENT
 Determine the extent of the client’s self-care abilities

 Client’s desire and need for oral hygiene
 Assess the client’s usual/routine for oral hygiene/mouth care practices (e.g., method,
frequency)
 Client’s knowledge of purpose and procedure
 Client’s ability to understand and follow instructions (e.g., to expectorate instead of
swallowing mouthwash and toothpaste)
 Inspect lips, gums, oral mucosa, and tongue for deviations from normal
 Status of palate, floor of mouth, throat, cheeks, tongue, gums, and teeth
 Identify presence of oral problems such as tooth caries, halitosis, gingivitis, and loose or
broken teeth, presence of lesions, and cavities
 Check if the client has bridgework or wears dentures. If the client has dentures, ask if any
tenderness or soreness is present and, if so, the location of the area(s) for ongoing
assessment
General Considerations
 If patient is able to brush his own teeth he should be permitted to do so

 Patients who are unable to perform it, should be assisted
 Oral hygiene procedure is carried out as part of the daily routine of each patient
Special Considerations
 Use a soft toothbrush or toothbrush or toothette for client receiving anti-coagulation

therapy. Dilute mouthwash for clients with oral lesions or sensitive oral tissues
 Young children may have loose teeth if permanent teeth have not all come in. Assess
carefully and use extra care. Use appropriate size toothbrush. Allow parents to participate.
Use care in avoiding aspiration
 Use extra care when performing oral care for elderly clients because they often have
problems with loose teeth due to retracting gums. Good oral care may promote good
appetite
 Pay special attention to the mouth and mucous membranes in clients who are mouth
breather to ensure that mucous membranes remain moist. Good grooming contributes to a
sense of well-being and peace
 Encourage client to perform as much as oral care as possible, and encourage family
members to assit, when necessary
Developmental Variations
 Teeth usually appear 5 to 8 months after birth. Baby-bottle syndrome may result in dental
caries (Edelman & Mandle, 2010). This syndrome occurs when an infant is put to bed with a
bottle of formula, milk, or fruit juice. The carbohydrates in the solution cause
demineralization of the tooth enamel, which leads to tooth decay. If the child wants a bottle
at bedtime, it should contain only water.
 By the time children are 2 years old, they usually have all 20 of their temporary teeth.
 At about age 6 or 7, children start losing their deciduous teeth, and these are gradually
replaced by the 33 permanent teeth.
 By age 25, most people have all of their permanent teeth. The incidence of periodontal
disease increases during pregnancy because the rise in female hormones affects gingival
tissue and increases its reaction to bacterial plaque.
 Many pregnant women experience more bleeding from the gingival sulcus during brushing
and increased redness and swelling of the gingiva (the gum). Teeth turn yellowish in color as
a part of the aging process.
 Teeth are normally off-white and with age, the enamel thins and the yellow-gray color of
the inner portion of the teeth begins to show. In addition, coffee drinking and cigarette
smoking can stain the teeth.
 Commercial teeth-whitening products and treatments offered at dental offices are available
to consumers who desire whiter teeth for cosmetic reasons. Lack of fluoridated water and
preventive dentistry during their developmental years have caused tooth and gum problems
in older adults (Edelman & Mandle, 2010, p. 631). As a result, some older adults may have
few permanent teeth left, and some have dentures.
 Loss of teeth occurs mainly because of periodontal disease (gum disease) rather than dental
caries (cavities); however, caries are also common in middle-aged adults. Some receding of
the gums and a brownish pigmentation of the gums occur with age. Because saliva
production decreases with age, dryness of the oral mucosa is a common finding in older
people.
Clients with Special Oral Hygiene Needs
 For the client who is debilitated or unconscious or who has excessive dryness, sores, or
irritations of the mouth, it may be necessary to clean the oral mucosa and tongue in
addition to the teeth. Agency practices differ in regard to special mouth care and the
frequency with which it is provided. Depending on the health of the client’s mouth, special
care may be needed every 2 to 8 hours.
 Mouth care for clients who are unconscious or debilitated is important because their
mouths tend to become dry and consequently predisposed to tooth decay and infections.
Saliva has antiviral, antibacterial, and antifungal effects. Dry mouth—called xerostomia—
occurs when the supply of saliva is reduced. This condition can be caused by side effects of
certain medications (e.g., antihistamines, antidepressants, antihypertensives). The drying
irritates the soft tissues in the mouth, which can cause inflammation and susceptibility to
infection (American Dental Association, 2013). Other reasons for a client to experience
xerostomia include oxygen therapy, tachypnea, and NPO status in which the client cannot
take fluids by mouth.
 For clients with special oral hygiene needs, the nurse focuses on removal of plaque and
microorganisms as well as client comfort. If possible, a soft-bristled toothbrush should be
used because it provides the best means of plaque removal. A sodium bicarbonate
toothpaste or diluted sodium bicarbonate (i.e., one part sodium bicarbonate to three parts
water) will help dissolve and remove viscous oral debris (Chan et al., 2011, p. 177). If the
client cannot tolerate the use of a toothbrush, the nurse can use an oral swab or a
gauzebecause aspiration of it can initiate an infection (lipid pneumonia). A water-soluble
moisturizer, absorbed by the skin and tissue, provides important hydration. Saliva
substitutes can also help moisturize the oral cavity. Use of lemonglycerin swabs is not
recommended because they irritate and dry the oral mucosa and can decalcify teeth.
Mouthwashes containing alcohol can irritate the oral mucosa and cause dryness. Mineral oil
is contraindicated as a moisturizer for the lips or inside the mouth.
LIFESPAN CONSIDERATIONS
 INFANTS - Most dentists recommend that dental hygiene should begin when the first tooth
erupts and be practiced after each feeding. Cleaning can be accomplished by using a wet
washcloth or small gauze moistened with water.
 CHILDREN - Beginning at about 18 months of age, brush the child’s teeth with a soft
toothbrush. Use only a toothbrush moistened with water. Introduce toothpaste later and
use one that contains fluoride. • Frequent snacking on products containing sugar increases
the child’s risk for developing cavities.
 OLDER ADULTS - Oral care is often difficult for certain older adults to perform due to
problems with dexterity or cognitive problems with dementia. • Most long-term health care
facilities have dentists that come on a regular basis to see clients with special needs. •
Dryness of the oral mucosa is a common finding in older adults. Because this can lead to
tooth decay, advise clients to discuss it with their dentist or primary care provider. • Decay
of the tooth root is common among older adults. When the gums recede, the tooth root is
more vulnerable to decay.
Home Care Considerations
 Assess the oral hygiene practices and attitude toward oral hygiene of family members and
the client. • Remind adults to replace their toothbrush every 3 to 4 months and a child’s
toothbrush more frequently.
 Clients with nasogastric tubes or who are receiving oxygen are likely to develop dry oral
mucous membranes, especially if they breathe through their mouths. More frequent oral
hygiene will be needed.
DELEGATION
 Oral care, brushing and flossing of teeth, and denture care can be delegated to the UAP.
After performing the above assessment, the nurse should instruct the UAP as to the type of
oral care and amount of assistance needed by the client. Remind the UAP to report changes
in the client’s oral mucosa.
Implementation of the Procedure

Providing Oral Care: Brushing the Client’s Teeth
Procedure/Steps Rationale
1. Perform hand hygiene and organize
equipment
2. Introduce self and Identify client.
Explain procedure to client and provide

privacy
3. Lower side rail and position client in one
of the following positions:
Supine at an angle greater than 45
degrees (if not contraindicated), side lying
position or prone with head turned to side
4. Don gloves
5. Drape towel under client’s neck and assist
client to rinse mouth with water
If Client Can Perform Self-care
6. Assist the client in brushing teeth:
 Provide a glass of water,
toothbrush, and toothpaste
 Moisten the toothbrush with
water and apply toothpaste to
brush. Allow client to brush teeth,
and instruct on proper technique
7. Assist the client in cleansing the oral
cavity:
 Provide mouthwash-soaked
toothette, or apply as appropriate
 Encourage client to swab inner
cheeks, tongue, and gums, or
perform these actions if needed
 Instruct client to rinse with
mouthwash and expectorate
 Instruct client to rinse and
expectorate any excess water
Optional: If the Client wanted to Floss -
Assist the client to floss independently, or floss
the teeth of an alert and cooperative client as
follows. Waxed floss is less likely to fray than
unwaxed floss; however, particles between the
teeth attach more readily to unwaxed floss than
to waxed floss. a. Wrap one end of the floss
around the third finger of each hand. b. To floss
the upper teeth, use your thumb and index finger
to stretch the floss. Move the floss up and down
between the teeth. When the floss reaches the
gum line, gently slide the floss into the space
between the gum and the tooth. Gently move the
floss away from the gum with up and down
motions (American Dental Association, 2014).
Start at the back on the right side and work
around to the back of the left side, or work from
the center teeth to the back of the jaw on either
side. c. To floss the lower teeth, use your index
fingers to stretch the floss. Give the client tepid
water or mouthwash to rinse the mouth and a
curved basin in which to spit
Note: Proceed to Step No. 8-11
If client Cannot Perform Own care
6. Perfom oral care on the client:
 Prepare toothbrush as described
above
 Apply brush to back teeth and
brush inside, top, and outside of
teeth. Brush from back to front,
using an up-and-down motion.
Repeat these steps, brushing teeth
on opposite side of mouth
 Allow client to expectorate or
suction excess secretion
 Instruct client to clench teeth
together, or grasp the mandible
and brush outside of front lower
teeth to upper teeth; brush
outside of front and side teeth
 Open mouth and brush top and
insides of teeth. Rinse toothbrush
and brush tongue
 Rinse toothbrush and brush teeth
again
 If use of dental floss is desired,
provide care at this time
7. Cleanse the oral cavity:
 Swab inner cheeks, lips, tongue,
and gums
 Irrigate mouth with mouthwash
and suction excess fluid
 Rinse with water and suction
excess
Note: Proceed to Step No. 8-11
If Client is Unconscious
6. Provide oral care:
 Brush teeth with toothbrush and
toothpaste as described above
step 6 in providing care for clients
who can’t provide their own care
 Irrigate mouth with small amounts
of water, suctioning constantly
7. Cleanse the oral cavity:
 Swab mouth with toothette
moistened with mouthwash. Begin
with inside cheeks and lips;
proceed to swab tongue and gums
 Rinse and suction excess
toothpaste and mouthwash,
water, and secretions and Wipe
lips with wet washcloth
 Apply petroleum jelly or mineral
oil to lips
8. Discard soiled materials; restore supplies
in proper care
9. Remove and discard gloves and perform
hand hygiene
10. Position client for comfort with call light
within reach
11. Documentation:
 Amount of care done by client, if
applicable
 Client’s response to activity
 Condition of oral cavityF
Prepared by:
PROF. MANUELA P. TIRAZONA

PROF. ANIELYNE G. PENETRANTE
PROF. EDNA P. LOR
PROF. JANET E. LACSA
Upadated-Modified by: DR. JENNIFER P. REYES, 2nd Semester 2020 -2021
I fully understand how I was graded for this skill and it was properly explained to me.
_____________________________
Student’s FULLNAME & Signature
Date: ______________
I have explained and discussed how I have graded my student for this particular skill.
___________________________________
Clinical Instructor FULLNAME & Signature
Date: _________

Intramuros, Manila
COLLEGE OF NURSING
Name: ________________________ Date: __________
Providing Special Oral Care for the Unconscious Client
Procedure Rationale
PREPARATION
1. Assessment
 Inspect lips, gums, oral mucosa, and tongue for
deviations from normal.
 Identify presence of oral problems such as tooth
caries, halitosis, gingivitis, and loose or broken
teeth.
 Assess for gag reflex, when appropriate.
2. Equipment • Towel • Curved basin (emesis basin) •
Clean gloves • Bite-block to hold the mouth open and
teeth apart (optional) • Toothbrush • Cup of tepid
water • Dentifrice or denture cleaner • Tissue or piece
of gauze to remove dentures (optional) • Denture
container as needed • Mouthwash • Rubber-tipped
bulb syringe • Suction catheter with suction apparatus
when aspiration is a concern • Foam swabs and
cleaning solution for cleaning the mucous membranes
• Water-soluble lip moisturizer
3. Introduce yourself, and verify the client’s identity.
Explain to the client/ family what you are going to
do,why it is necessary and how the client can
cooperate.
4. Perform hand hygiene, and observe other appropriate
infection control procedures.
5. Provide for client privacy.
6. Prepare the client.
• Position the unconscious client in a side-lying
position, with the head of the bed lowered. If the
client’s head cannot be lowered, turn it to one side.
 Place the towel under the client’s chin. • Place the
curved basin against the client’s chin and lower cheek
to receive the fluid from the mouth.
• Apply gloves.
7. Clean the teeth and rinse the mouth. • If the person
has natural teeth, brush the teeth. Brush gently and
carefully to avoid injuring the gums. If the client has
artificial teeth, clean them.
• Rinse the client’s mouth by drawing about 10 mL of
water or alcohol-free mouthwash into the syringe and
injecting it gently into each side of the mouth.
• Watch carefully to make sure that all the rinsing
solution has run out of the mouth into the basin. If not,
suction the fluid from the mouth
• Repeat rinsing until the mouth is free of dentifrice, if
used
8. Inspect and clean the oral tissues.
• If the tissues appear dry or unclean, clean them with
the foam swabs or gauze and cleaning solution
following agency policy.
• Use a moistened foam swab to wipe the mucous
membrane of one cheek. Discard the swab in a waste
container; use a fresh one to clean the next area.
• Clean all mouth tissues in an orderly progression,
using separate applicators: the cheeks, roof of the
mouth, base of the mouth, and tongue.
• Observe the tissues closely for inflammation and
dryness.
• Rinse the client’s mouth.
9. Ensure client comfort.
• Remove the basin, and dry around the client’s mouth
with the towel.
• Lubricate the client’s lips with water-soluble
moisturizer.
10. Remove and discard gloves.
• Perform hand hygiene.
11. Document assessment of the teeth, tongue, gums, and
oral mucosa. Include any problems such as sores or
inflammation and swelling of the gums.
12. EVALUATION
• Consider the client’s medical diagnosis and treatment
(e.g., chemotherapy, oxygen) and the necessary
nursing interventions related to oral hygiene.
• Conduct an ongoing assessment, if appropriate, of
the oral mucosa, gums, tongue, and lips. Report
deviations from normal to the primary care provider.
• Conduct appropriate follow-up such as a referral to a
dentist for dental caries.
Prepared by:
PROF. MANUELA P. TIRAZONA
PROF. ANIELYNE G. PENETRANTE
PROF. EDNA P. LOR
PROF. JANET E. LACSA
Edited by: DR. JENNIFER P. REYES, 2nd Semester 2020 -2021
_____________________________
Date: ______________
___________________________________
Date: _________

Intramuros, Manila
COLLEGE OF NURSING
Name: ________________________ Date: __________
Performing Denture Care
Purpose
 Decreases microorganisms in mouth an on dentures

 Decreases buildup of food residue on teeth or dentures
 Improves appetite and taste of food
 Promotes comfort
 Stimulates circulation to oral tissues, tongue, and gums
 Improves appearance and self-esteem
 To cleanse dentures
 To prevent halitosis and formation of sores
Equipment
 Denture brush
 Denture cream
 Denture cup
 Denture cleaner
 Emesis basin
 Non sterile gloves
 Towel or linen saver and washcloth
 Cup of warm water & Cup of cool water
 Glass of water
 Pen
Assessment – should focus on the following
 Client’s desire and need for oral care

 Client’s usual routine for oral hygiene and denture care (e.g., method, frequency)
 Client’s knowledge of purpose and procedure
 Client’s ability to understand and follow instructions
 Status of palate, floor of mouth, throat, cheeks, tongue, and gums (e.g., presence of lesions)
Special Considerations
 Dentures are breakable and must be kept in safe place
 Dentures should not be washed directly over sink
 Dentures can be extremely fragile, expensive, and difficult to replace once damaged, lost.
Extreme caution should be exercised in handling and care
 Elderly clients often wear dentures. Assess their mouth for irritation from poorly fitting
dentures
 Encourage client to perform as much oral care as possible, and encourage family members
to assist, when necessary
Implementation of the Procedure
Procedure/Steps Rationale
1. Perform hand hygiene and organize
supplies/equipment
2. Introduce self and verify client.
3. Explain procedure to client and

encourage participation, if able
4. Provide privacy
5. Don gloves
6. Place towel over client’s chest
7. Assist client with denture removal:
 Fill denture cup halfway with cool water
and add denture cleanser to the water
per manufacturer’s instructions
 Give the client a glass of water. Instruct
the client to take a sip. Ask the client to
hold water in mouth and “float”
dentures loose
 Aloow client to remove dentures, or
gently rock dentures back and forth
until they are free from gums
 To remove, lift bottom dentures up and
pull top dentures down
 Place dentures in denture cup to soak

( if a denture cup is unavailable, use
emesis basin or other receptacle and
label clearly)
8. Assist client with cleansing oral cavity:
 Provide a mouthwash-soaked toothette
 Encourage client to swab inner cheeks,
lips, tongue and gums
 Instruct client to swirl mouthwash in
mouth and expectorate. Follow with
water, as desired
9. Cleanse dentures:
 Apply denture cleaner and brush
dentures using the technique described
for brushing teeth
 Throughly rinse paste from dentures
with cool water
10. Reinsert dentures:
 Apply denture cream to gum side of
denture plate
 Insert upper plate and press firmly to
gums. Repeat with lower plate
11. Apply petroleum jelly or mineral oil to
client’s lips
12. Remove towel from client’s chest.
Discard soiled materials
13. Remove and discard gloves and perform
hand hygiene
14. Position client for comfort, with side
rails raised and call light within reach
15. Place personal hygiene items in client’s
drawer or on bedside table
16. Document:
 Amount of care done by client
 Client’s response to activity
 Condition of the oral cavity and lips
Prepared by: DR. JENNIFER P. REYES, 2nd Semester 2020 -2021
_____________________________
Date: ______________
___________________________________
Date: _________

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PAMANTASAN NG LUNGSOD NG MAYNILA

(University of the City of Manila)

BACON – SKILLS LABORATORY CHECKLIST #

Name: ________________________ Date: __________

Providing Oral Care: Brushing the Client’s Teeth

 Determine the extent of the client’s self-care abilities

 If patient is able to brush his own teeth he should be permitted to do so

 Use a soft toothbrush or toothbrush or toothette for client receiving anti-coagulation

Clients with Special Oral Hygiene Needs

Home Care Considerations

Implementation of the Procedure

Explain procedure to client and provide

PROF. MANUELA P. TIRAZONA