Here is a pdf copy of the following information: Oral Care Procedures. Non-commercial “fair use” is permitted (i.e., copying for facility or patient use). Otherwise, may be used with permission.
Oral Care Procedures for the Dependent Patient
© 2014 Karen Sheffler of SwallowStudy.com
Perform every shift (before/after meals as needed)
Oral Care Tools:
Toothbrush (on suction if available), swabs (on suction if available), extra toothettes/swabs to apply mouthwash and moisturizer, Yankauer-oral suction, mouthwash, oral moisturizer, water-based lip moisturizer, gloves, and Chlorhexidine* measured out in medicine cup if prescribed by doctor.
1. Sit the patient fully upright or in an elevated side-lying position to prevent aspiration during mouth cleaning.
2. Inspect the patient’s mouth:
- Check lips, teeth, gums, inside cheeks, tongue, and mucosa of floor and roof of mouth.
- Note any food, coating, bleeding, dryness, edema, redness, or other debris.
- Note degree of saliva pooling (excessive secretions?).
3. Remove loose material or debris (especially important if patient is NPO/Nothing by Mouth):
- Use Yankauer suction to remove excessive secretions and loose debris.
- Use Suction Swab (or toothette if Suction Swab not available) to remove as much debris as possible.
- Scrub tongue, gums, and entire roof of mouth.
- Use Perox-A-Mint Solution (1.5% Hydrogen Peroxide) on the swabs if mechanical action is needed to assist in debridement.
- Avoid Hydrogen Peroxide if oral thrush and/or oral lesions.
- Instead try a baking soda solution: 1 tsp of baking soda in 8 oz of water (this does not replace prescribed treatment for the thrush).
4. Brush the teeth with toothpaste. A Suction Toothbrush is best to reduce the risk for aspiration of contaminated water, saliva and debris. Otherwise an electric toothbrush is more thorough than a regular brush. If the above are not available, use a soft toothbrush along with a separate oral suction.
- If dentures, remove, gently brush and rinse. Soak dentures overnight.
- Gently brush teeth in circular motions at a 45 degree angle to the gum line.
- Brush for 1-2 minutes to remove plaque build-up.
- Some bleeding is okay, unless contraindicated (i.e., low platelet count/bleeding risk). Mild bleeding indicates the need for consistent and improved oral care.
- Brush the tongue.
5. Rinse the mouth with Suction Swab or clean-moist toothette & Yankauer suction.
6. Mouthwash*: dip toothette into a standard oral rinse. Most mouthwashes at the hospital contain 0.05% Cetylpyridinium Chloride (anti-fungal and anti-bacterial) to reduce the risk of infection and to remove plaque.
- Swab along teeth, gums, tongue, roof of mouth.
- Suction to remove excess.
7. Mouth and lip moisturizer: apply moisturizer inside the mouth with a toothette (e.g., artificial saliva substitute, like Biotene or a mouth moisturizer from the oral care kits). Apply water-based moisturizer with Vitamin-E or similar substance to the lips with gloved finger (avoid petrolatum-based products, as these do not penetrate and heal tissue).
8. *If indicated and prescribed, use 0.12% Chlorhexidine Gluconate (CHG): for treatment of gingivitis (i.e., redness, swelling and bleeding of gums), for a strong anti-microbial, if the patient is intubated, and to reduce pneumonia risk.
- Apply after breakfast and before bed, after oral care steps #1-5.
- DO NOT use mouth moisturizer in step #7 if CHG indicated. Apply mouth moisturizer at another time in the day as needed.
- DO NOT rinse mouth, eat or drink for 30 minutes after using CHG.
- DO NOT swallow: Swab around mouth completely and suction excess.
By Karen Sheffler