A Nurse Is Providing Oral Care to a Client With Dentures. What Action Would the Nurse Perform First?

Effective oral hygiene and denture intendance are crucial for patients' health, and a fundamental nursing responsibleness. This article describes principles and techniques of adept rima oris intendance

Abstract

Oral care is a fundamental office of nursing intendance and failure to provide information technology can have a negative effect on wellness and wellbeing. This article explains the procedure for oral and denture care.

Citation: Otukoya R, Shepherd E (2018) Principles of constructive oral and denture care in adults. Nursing Times [online]: 114: 11, 22-24.

Authors: Rachael Otukoya is a dentist in special intendance dentistry and dental public wellness at East Surrey Hospital; Eileen Shepherd is clinical editor, Nursing Times.

• This article has been double-blind peer reviewed
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• Read our article on tools for mouth intendance delivery here

Introduction

Oral wellness is essential to good health and quality of life, and is defined past the World Wellness Organization (2018) as "a state of beingness free from mouth and facial hurting, oral and throat cancer, oral infection and sores, periodontal (gum) disease, molar decay, tooth loss, and other diseases and disorders that limit an individual's capacity in bitter, chewing, smiling, speaking, and psychosocial wellbeing".

Maintaining patients' oral hygiene is an essential nursing duty and is considered a fundamental aspect of care (Department of Wellness, 2010). Prove suggests that oral wellness deteriorates while people are in hospital (Terezakis et al, 2011) and it is generally acknowledged that mouth care in hospitals and care homes needs to be improved (Binks et al, 2017). Barriers to providing effective oral care include:

• Lack of staff training;
• Lack of oral cavity care cess tools, policies and equipment (Binks et al, 2017).

In response to concerns, in 2015 Heath Instruction England launched Mouth Intendance Matters to better oral intendance for adults in intendance homes and hospitals (Box 1).

Box 1. Oral cavity Care Matters

The Rima oris Care Matters initiative states that staff demand to take:

• Knowledge of expert mouth care and how oral health is linked to general health and wellbeing
• Skills on how to assess and carry out mouth care
• Tools, such every bit toothbrushes and denture pots, to comport out mouth care effectively
• Support from doctors and dental practitioners where necessary

Reasons for poor oral hygiene

At that place are many reasons people may take poor oral hygiene, including:

• Inability to acquit out oral intendance, for instance due to stroke, arthritis, arm injury, head injury, surgery;
• Lack of noesis or motivation;
• Lack of access to dental services;
• Lack of money to beget oral intendance equipment;
• Medicines, such as anticholinergic drugs and oxygen therapy, that cause a dry mouth or an unpleasant taste;
• Poor nutrition or reduced fluid intake (Wilson, 2011);
• Nil by mouth due to surgery or dysphagia;
• Xerostomia – awareness of a dry mouth – which frequently affects older people;
• Surgery, radiotherapy and/or trauma to the head and neck (Dougherty and Lister, 2015).

Benefits of a clean mouth

Providing effective mouth care to patients can:

• Promote cocky-esteem and condolement (Wilson, 2011);
• Better appetite and enjoyment of food and beverage – poor nutrition associated with oral problems tin ho-hum recovery and increment length of hospital stay (Binks et al, 2017);
• Prevent halitosis;
• Reduce the risk of hospital-caused pneumonia (Pássaro et al, 2016; Pace and McCollough, 2010).

How frequently should oral care exist carried out?

Teeth should exist brushed at least twice a solar day with a fluoride toothpaste (Public Wellness England, 2017; National Constitute for Health and Care Excellence, 2016). They should ever exist brushed last thing at night.

In hospital and care homes frequency can be determined using an oral assessment tool and depends on individual need. Patients receiving oxygen therapy, nil by mouth or those who are airsickness will require frequent oral fissure care. Nurses should prompt and back up patients to acquit out oral care and undertake oral care for those who cannot maintain a clean oral cavity for themselves (Overnice, 2016).

Oral assessment

A pen torch and natural language depressor can brand it easier to see inside the oral cavity. The assessment will:

• Provide baseline information nearly the status of the patient's oral cavity;
• Help monitor progress of oral care/treatments;
• Identify whether the patient has a denture or appliance to forestall it being lost while in hospital.

Fig 1 details the features that volition be evident in a healthy oral crenel. Oral cess will help to identify problems such as:

• Dry out oral cavity and lips;
• Coated tongue;
• Broken teeth/stumps;
• Thick tenacious secretions;
• Dry, sore lips;
• Ulcers;
• Plaque and dental caries;
• Candidiasis (oral thrush) (Fig 2).

The patient should be referred to a dental professional if there are concerns about excessive plaque, sick-plumbing equipment dentures or multiple/long-continuing ulcers.

Source: Peter Lamb

The procedure for oral hygiene

Equipment

• Pen torch;
• Receiver;
• Tissues;
• Tongue depressor;
• Non-sterile disposable gloves and plastic apron;
• Toothbrush – this is the most effective means of removing plaque and droppings. A paediatric soft toothbrush can be used for patients who take a sore mouth;
• Toothpaste;
• Assessment and recording tools.

In 2012 the Medicines and Healthcare products Regulatory Agency issued an alert advising that cream swabs should not be used with patients as the foam heads can become detached (MHRA, 2012). Many organisations have later on banned them on patient safety grounds. They are non as effective as a toothbrush at removing dental plaque and should not be used equally a replacement for toothbrushes (Pearson and Hutton, 2002).

Procedure

1. Explain the procedure to the patient and gain their consent to carry information technology out.
2. Screen the patient to ensure privacy during the process. Oral hygiene should take identify in the bathroom, where possible.
3. Wash and dry out your hands.
4. Assemble equipment.
5. Enquire the patient to sit in an upright position or help them to do this. If the patient is unable to sit upward, the procedure should be undertaken with the patient'southward caput turned to the side to preclude choking and suction equipment should be bachelor.
6. Wash and dry hands once again, and put on non-sterile gloves and a plastic apron.
7. Select an appropriate toothbrush and wet the head. Use a pea-sized corporeality of toothpaste to a gloved finger and rub it into the toothbrush – this volition forestall a large amount of toothpaste from dropping into the patient'southward rima oris. Non-foaming toothpaste should be used for patients with dysphagia (swallowing bug) (Doshi, 2016).
8. Use a gentle, rotating motion to clean the inner, outer and biting surfaces of the teeth (Fig 3). You can also gently brush the surface of the natural language and the gums. Brushing should take approximately two minutes, or xxx seconds per quarter of the oral cavity.
9. Allow the patient to spit out excess toothpaste. They should not rinse their mouth with h2o as this dilutes the fluoride in the toothpaste, which protects teeth from decay (PHE, 2017).
10. Offer the patient tissues to wipe their mouth.
11. Apply moisturiser to the patient'south lips if required. Dry-mouth gel can be used to alleviate oral dryness.
12. Check the patient is comfortable.
13. Clean the toothbrush and let it to air dry.
14. Remove gloves and frock, and dispose of equipment according to local policy.
15. Wash and dry out your hands.
16. Certificate care given and any observations of the patient's mouth.

Source: Peter Lamb

Procedure for denture care

Good denture hygiene is essential equally food and debris tin can collect under dentures. Denture care reduces the risk of developing problems such every bit oral thrush.

Loss of dentures is a major problem in hospital and affects patients' ability to eat and communicate, and may also bear on their psychological wellbeing (Binks et al, 2017). Obtaining new dentures is expensive and inconvenient for patients.

Oral fissure Care Matters identifies iii primal principles for denture care (Doshi, 2016):

• Dentures should be cleaned at least one time daily and, ideally, after meals with a denture brush or toothbrush and soap over a bowl filled with h2o;
• They should be removed at night and stored in water, in a labelled denture pot;
• An incident report grade must be completed by wards for every denture that is lost.

Equipment

• Small torch;
• Plastic loving cup;
• Mouthwash;
• Denture cleaner;
• Denture brush;
• Non-sterile disposable gloves and frock;
• Denture pot;
• Tissues.

Procedure

1. Explicate the procedure to the patient and gain their consent to carry information technology out.
2. Wash and dry out your hands.
3. Get together equipment.
4. Fill a disposable bowl with water.
5. Wash and dry out your hands over again, and put on the non-sterile gloves and apron.
6. Ask the patient to remove the denture from their oral cavity and place it in the bowl of water.
7. Allow the patient to rinse their mouth with water. A soft toothbrush may besides be used to gently brush the gums.
8. If the patient needs assistance to remove the denture, slide a gloved finger past the side of information technology to assist intermission the seal between the mouth and the denture (Doshi, 2016) (Fig iv).
9. Acquit out an oral assessment using a pen torch if required.
10. Clean the denture using a denture brush or soft toothbrush and denture cleaner. Toothpaste should non be used as this can exist annoying (Doshi, 2016).
11. Check the denture for harm, such every bit cracks or sharp edges.
12. Rinse the denture with cold h2o before repositioning it in patient'southward rima oris or storing it in water in a denture pot. Propose the patient to exit the denture out at night to allow the oral tissue to recover.
13. Ever use a dedicated denture container, carefully labelled with the patient's details according to local policy.
14. Cheque the patient is comfy.
15. Clean the denture brush and allow information technology to air dry.
16. Remove your gloves and apron, and dispose of the equipment co-ordinate to local policy.
17. Wash and dry your hands.
18. Document the care and any observations of the oral cavity.
19. If the patient has a fractional denture it is important that they also clean their remaining teeth. Split up molar brushes should be used for dentures and teeth (Doshi, 2016).

Source: Peter Lamb

References

Binks C et al (2017) Standardising the delivery of oral health care practice in hospitals. Nursing Times; 113: 11, 18-21.

Section of Health (2010) Essence of Care 2010: Benchmarks for Fundamental Aspects of Intendance. London: DH.

Doshi M (2016) Mouth Intendance Matters: A Guide for Hospital Healthcare Professionals.

Dougherty L, Lister S (2015) The Regal Marsden Hospital Manual of Clinical Nursing Procedures. Oxford: Wiley Blackwell.

Medicines and Healthcare products Regulatory Agency (2012)Medical Device Alert. Oral Swabs with a Cream Head.

National Institute for Wellness and Care Excellence (2016) Oral Wellness for Adults in Intendance Homes.

Pace CC, McCullough GH (2010) The clan betwixt oral microorganisms and aspiration pneumonia in the institutionalized elderly: review and recommendation. Dysphagia; 25: 4, 307-322.

Pássaro L et al (2016) Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review. Antimicrobial Resistance and Infection Control; 2016; v: 43.

Pearson LS, Hutton JL (2002) A controlled trial to compare the ability of foam swabs and toothbrushes to remove dental plaque. Journal of Advanced Nursing; 39: 5, 480-489.

Public Wellness England (2017) Delivering Better Oral Health: An Show-based Toolkit for Prevention.

Terezakis East et al (2011) The touch on of hospitalization on oral health: a systematic review. Journal of Clinical Periodontology; 38: 7, 628-636.

Wilson A (2011) How to provide constructive oral care. Nursing Times; 107: 6, xiv-15.

World Health Organization (2018) Oral Health.

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Source: https://www.nursingtimes.net/roles/hospital-nurses/principles-of-effective-oral-and-denture-care-in-adults-29-10-2018/

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