objectives: - manchester university nhs foundation...
TRANSCRIPT
To provide guidance and information regarding the provision of oral hygiene for hospitalised patients
AIM:
• To label the functions and structures of the oral cavity
• To discuss the importance of effective oral hygiene
• To list client groups who may require assistance with oral hygiene
• To recognise the need to individual patient assessment
Objectives:
• To recognise the need to individual patient assessment
• To discuss the methods/medication that support oral hygiene provision
• To state how to perform oral care/assessment • To recognise some common symptoms associated with oral conditions
Objectives:
•Pink moist tongue, oral mucosa & gums •Teeth/dentures clean and free from debris •Well fitting dentures •Adequate salivation •Smooth moist lips •No difficulties eating or swallowing
What Should a Healthy Mouth look like?
• Initial breakdown of food products utilising teeth and saliva.
• Taste • Communication/social interaction • Breathing
Functions of the Oral Cavity
• Communication • Comfort • Ease of oral intake • General health • Problems can be life threatening
The Important of Oral Care Oral Hygiene
Conditions/Treatments which increase patients risk of oral complications
Conditions •Diabetes •Renal failure •Malnutrition •Dehydration •Physical disability/unable/
uncooperative •Depression •HIV/Immunosupressed
patients
Treatments
•Oxygen therapy •Radiotherapy to the
head & neck •Intermittent suction
Thurgood (1994)
Drugs • Antibiotics • Phenytoin • Diuretics • Antidepressants • Morphine
Drug Treatments which increase patients risk of oral complications
• To maintain the oral mucosa and keep it clean soft moist and intact
• To keep natural teeth free from plaque • To maintain denture hygiene and prevent denture induced disease
Objectives of oral care
• To prevent infection • To prevent oral discomfort • To encourage adequate nutritional intake
• To maintain the mouth in a state of normal function
Objectives of oral care
• Assessment is required, not only for those in obvious need of care, but where treatment is preventable
• Care should be evidence based, and tailored to meet the patients individual requirements
• Oral hygiene assessment tool
How Can We as Nurses Help?
Physical Feature:
Teeth / Dentures
Mucous Membranes
Lips
Saliva
Gums
Observe For:
Plaque, debris or dental Caries or illfitting dentures Coating, redness, ulceration Or bleeding Cracking, bleeding or ulceration
Consistency & Quantity
Redness, ulceration & bleeding
What do we Look for When Giving Oral Care
Toothbrush:
should be the first line of oral cleansing, as it effectively reduces plaque and gingivitis (Pearson et al 2002), and is proven to be more effective than foam swabs at removing plaque and cleaning approximal and crevice sites
Products to Support Oral Hygiene
Fluoride Toothpaste: Recommended and recognised as the most effective and safest cleansing agent, fluoride reduces the incidence of dental caries and prevents cavities
(Beck and Yasko 1993)
Products to Support Oral Hygiene
• Swabs:Use when tooth brushing not advisable
• Not as effective as tooth brushing, useful to remove debris, plaque, and for patient comfort
Products to Support Oral Hygiene
• Sodium Bicarbonate:appropriately diluted according to manufacturers instructions to dissolve viscous mucous and remove debris
Products to Support Oral Hygiene
Pink Mouth Wash Tablets Glycerin Thymol
• This solution is useful for refreshing the mouth, but it has no therapeutic effect and is not antimicrobial
(Heals D 1993).
Products to Support Oral Hygiene
Chlorhexidine corsodyl Use under prescription to complement oral care procedure, has broad spectrum antibacterial and antifungal activity, can aid prevention of plaque, caries and gingivitis – prolonged use can alter taste perception and cause yellow/brown superficial stain.
Products to Support Oral Hygiene
• Lubricants such as petroleum jelly, and yellow paraffin are often recommended for lips (Caution with Oxygen therapy … combustion)
• Moisturising cream is a good alternative
• Lip balms
Lip Care
• Water – safest moisturising agent causing minimal disruption to the oral ecosystem (Gooch 1989)
• Tinned pineapple – contains proteolytic enzyme which has a cleaning effect on the mouth (Rawlins 2001)
Oral care agents/tools
Clean dentures with toothbrush and toothpaste at least once per day, ensure removal prior to oral assessment.
Ensure container is cleaned and replaced weekly, and correctly labelled to identify owner.
Dentures:
• Literature search reveals no consensus
• Regularity should be related to the clients condition and his/her need.
• Assessment is essential to evaluate the care you are giving and the frequency required
How often do you perform mouth care?
• Wash hands • Gloves should be worn • A good light/pen torch is essential to identify changes/establish a base line
• Tongue depressors help to see difficult areas hidden by the tongue
• If the patient wears dentures they should be removed prior to any oral assessment
• Oral hygiene packs
Procedure
• Divide yourselves into groups of 5, one volunteer required to undertake the mouth care, one group member to be in receipt of it, one to feedback regarding COMFORT & REFRESHMENT VALUE
• Group 1 Gloves, pink sponges, mouth wash • Group 2Gloves pink sponges, pineapple • Group 3Gloves gauze, forceps • Group 4 Gloves gauze digital • Group 5Gloves toothbrush toothpaste
Practical Session
Oh ..no … the bit you’ve all been waiting for
Mouth cancer can affect the lips, tongue, cheeks and throat.
• Signs • Treatment • Precipitating factors
My Department!
• http://www.colgate.com/app/Colgate/US/OC/Information/Intera ctiveGuides/SmileSaver.cvsp
• http://www.colgate.com/app/Colgate/US/OC/Information/ArticleI ndex.cvsp
• Fitzpatrick, Joanne (2000) Oral health care needs of dependent older people: responsibilities of nurses and care staff. Journal of Advanced Nursing. 32(6):13251332.
• Xavier, G (2000) The importance of mouth care in preventing infection. Nursing Standard. 14(18):4752,
Useful Information