Oral care in adults

Rationale for oral care

The Department of Health's Essence of Care document (2010) emphasised that oral hygiene is a priority and a standard facet of patient care. Nurses, who work at the heart of health care, may find themselves as the first point of contact with patients who require assistance with oral care or who are experiencing oral problems (Brooker and Nicol, 2015).

The mouth is the most important part of the face: it is required both for communication and to consume food and drink. It is therefore important to adhere to good oral cavity hygiene, to avoid both of these functions being severely affected (Peate, 2010). Conditions such as xerostomia (dryness of the mouth) can pose complications, such as infection or oral thrush and ulceration (Dougherty et al, 2015).

Poor oral hygiene may result in the following:

• pain and discomfort, which may result in a reduced oral intake
• increased

Assessment of the mouth

Eilers et al (1988) devised a simple tool for assessing the mouth based on six categories: lips, tongue, saliva, mucous membranes, gingival and teeth (Peate, 2010). Although there are several tools that can be used to assess oral health, evidence is limited on their effectiveness (Brooker and Nicol, 2015). Another tool that can be used to assess the condition of the mouth includes the Oral Health Risk Assessment, which can help identify a trauma or fractured teeth, unstable dentures, dry mouth, infections or sores, and complications related to the tongue (British Society of Gerodontology, 2010).

Promoting self-management

There are several ways in which health professionals can promote oral hygiene (Public Health England, 2014). These include offering patients advice to brush their teeth at least twice a day with a fluoridated toothpaste—this can be last thing at night and then on one other occasion. Patients should also

General oral care

Equipment

The following items may be necessary for nurses to provide oral care:

• plastic apron
• non-sterile disposable gloves
• small torch
• wooden spatula
• gauze (to wipe spillages)
• plastic cups
• appropriate equipment for cleaning, eg foam sticks/toothbrush
• clean receiver or bowl
• paper tissues
• small-headed, soft toothbrush
• toothpaste (fluoride preferred)
• dental floss
• mouthwash (0.2% chlorhexidine)
• Llp lubricant (non-petroleum based) (Baillie, 2014; Dougherty et al, 2015; Public Health England, 2014)

The additional equipment may be required to care for denture wearers:

• denture pot
• denture brush
• denture paste, soap and soaking solution

Procedure

1. Gather the necessary equipment.
2. Explain the procedure to the patient, gain consent and encourage independence in carrying out the task
3. Wash your hands or decontaminate them with the appropriate solutions. Put on plastic apron and disposable gloves
4. Prepare the mouthwash
5. Carry out the oral assessment using an oral assessment tool to establish the baseline for monitoring
6. Using the torch, spatula and gauze inspect the patient's mouth, including teeth, lips and buccal mucosa. Observe the lateral and ventral surfaces of the tongue, floor of the mouth and the soft palate
7. Ask the patient whether they have experienced any changes with taste, saliva production or composition, and establish if there are any problems such as oral discomfort or problems swallowing
8. Using a small soft toothbrush and a pea-sized amount of toothpaste, brush the patient's natural teeth, gums and tongue
9. Hold the toothbrush at a 45° angle, the tips of the outer

Conclusion

This article has outlined the importance of mouth care and discussed some considerations in relation to providing oral care within clinical practice. The role of the nurse in providing an assessment of oral health has also been highlighted, alongside key considerations in relation to maintaining good oral hygiene. It is hoped that this step-by-step guide to providing oral hygiene for both natural teeth and dentures will help nurses in this task.

References

Baillie L. Developing practical nursing skills. 4th edn. Boca Raton (CA): CRC Press/Taylor and Francis Group; 2014 

British Society of Gerodontology. Guidelines for the oral healthcare of stroke survivors. 2010. https://www.gerodontology.com/content/uploads/2014/10/stroke_guidelines.pdf (accessed 19 December 2022) 

Brooker C, Nicol M. Alexander's nursing practice. (4th edn). Edinburgh: Churchill Livingstone/Elsevier; 2015 

Department of Health. Essence of care 2010. 2010. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216691/dh_119978.pdf (accessed 19 December 2022) 

Dementia UK. Mouth care for people with dementia. 2021. https://www.dementiauk.org/get-support/health-issues-and-advice/mouth-care-dementia/ (accessed 19 December 2022) 

Dougherty L, Lister S, West-Oram A. The Royal Marsden manual of clinical nursing procedures student edition. (9th edn). Oxford: Blackwell Publishing; 2015 

Eilers J, Berger AM, Petersen MC. Development, testing, and application of the oral assessment guide. Oncol Nurs Forum. 1988;15(3):325–330 

Health Education England. Mouth care matters: adults. 2018. http://www.mouthcarematters.hee.nhs.uk (accessed 25 July 2019)

Peate I. Nursing care and the activities of living. (2nd edn). Chichester: Wiley Blackwell; 2010 

Public Health England. Delivering better oral health: an evidence-based toolkit for prevention. 2014. https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention (accessed 19 December 2022) 

Stout M, Goulding O, Powell A. Developing and implementing an oral care policy and assessment tool.