Basic Principles of Mouth Care For Unconscious Patient

Good mouth care is essential at every stage of life. However, some people cannot perform oral hygiene practice regularly, primarily those unconscious due to their health conditions. Mouth care for the unconscious patient may require a professional health care assistant to safely and adequately keep their mouth healthy despite the situation. Even with dentures, proper dental care is required. Keep reading the article to know more about the importance and procedure of mouth care for unconscious patients.

About Oral Hygiene

Good dental or oral hygiene is significant for your general health. It comprises a daily practice of cleaning your mouth, teeth, and gums. Appropriate oral care helps promote healthy gums, teeth, and fresh breath.

Significance of Oral Care in Nursing

Also known as mouth care, oral care is quite possibly the most basic nursing activity. Maintaining the mouth and teeth clean will ensure a patient’s oral health and permit faster recovery by forestalling infections. When the patient is unconscious, mouth care will be necessary all the more regularly. Usually, unconscious patients inhale through the mouth, making secretions dry. Indeed, it is a crucial part of patient care that should be completed consistently by a nurse. Furthermore, the health care staff or nurse plays a vital role in giving possible oral care and advancing the oral hygiene of an unconscious patient. In fact, nurses should know the risk factors related to poor oral health and evaluate and help patients keep up oral hygiene.

Performing Oral Hygiene for an Unconscious Patient

There are six steps to properly execute oral hygiene for unconscious patients. These include safety, equipment, delegation, execution, follow up and documentation.

Safety

Remember the following guidelines to safely perform mouth care for an unconscious patient:

• Examine the patient for the presence or nonappearance of a gag reflex.
• Apply standard precautions when giving oral care, such as wearing clean gloves. Also, additional safety measures requiring other personal protective equipment (PPE) might be essential, contingent upon the patient’s condition.
• Do not utilize your fingers to examine the mouth. Regularly utilize a tongue blade to stay away from the patient’s reflex to chomp down.
• Place the unresponsive patient in the side-lying condition. The patient’s head went aside and toward the sleeping pad in a dependent position. Lift the head of the bed to something like 30 degrees.
• Importantly, secure the patient from aspiration and choking. Adhere to aspiration preventive measures by applying an oral suction catheter to free oral discharges. The most secure strategy is to have two nurses give care. One will do the oral care while the other will suctions secretions as fundamental with a Yankauer suction tip.
• Routine suctioning of the oral cavity is necessary to manage oral secretions to lessen the risk for aspiration.

Equipment

A plate containing supplies and equipment required for mouth care or oral care are the following:

• Clean gloves
• Water glass with cool water
• Mouthwash or antibacterial solution
• Emesis basin
• Toothette sponges or soft pediatric toothbrushes
• Fluoride toothpaste
• Tongue blade
• Suction catheter
• Oral airway
• Penlight
• Water-soluble lip moisturizer

Delegation

After evaluating the patient for a gag reflex, the ability to do oral care for a debilitated or unresponsive patient can be delegated to the health care nurse. Make sure to communicate the following:

• Discuss the correct positioning of the patient for oral care.
• Clarify any special preventive measures, such as Aspiration Precautions.
• Then, go over again the utilization of an oral suction catheter to clear oral discharges.
• Advise the nurse to report to you any indications of hindered integrity of the oral mucosa.
• Also, instruct the nurse to report to you promptly any bleeding of gums or mucosa or excessive choking or coughing.

Procedure

Mouth care procedure is applicable for unconscious patients or those who are not able to eat or drink. The proper process for oral care includes:

Preparation:

• Arrange all tools and equipment on the bedside cabinet or an overbed table.
• Then, position the patient’s bed in a comfortable situation and lower one side rail.
• Place a bulb needle or suction machine nearby.
• After that, position the patient in a side-lying position and set up the bed on one side so that the unresponsive patient is in a half-sitting position.

During:

• Wash your hands appropriately with antiseptic soap and warm water.
• Then, use the gloves after drying your hands.
• After that, place towel or waterproof cushion under the patient’s chin
• Maintain the kidney tray under the patient’s cheek or eliminate discharges from the mouth by the suction catheter.
• Use a cushioned tongue blade to open teeth softly. Never stick your fingers in an unresponsive patient’s mouth.
• Then, bring the head of the patient towards you in a delicate way.
• Clean the mouth, teeth, gums, and tongue with a toothbrush and toothpaste.
• Additionally, apply an Asepto syringe or flooding bulb without a needle to wash the oral cavity. Then, swab or utilize oral suction to eliminate pooled discharges.

After:

• Clean right after brushing and suction the saliva and toothpaste from the patient’s mouth.
• Wipe out the additional water on the mouth with a clean towel.
• Removes basin, dries mouth and face, and uses water-soluble lip moisturizer.
• Then, put the patient back in a comfortable position.
• Set up the side rail and lower bed position.
• Lastly, dispose of the gloves in a paper bag and wash hands appropriately.

Follow Up

After cleaning the patient’s mouth, evaluate the patient for aspiration. If there is, do the following:

• To keep up airway patency, suction the oral air pipe as secretions gather.
• Then, lift the top of the bed to work with breathing.
• After that, inform the doctor, and prepare the patient for a chest x-ray exam.

Use clean gloves, and review the oral cavity for cleanliness. Also, examine your pre-procedure and post-procedure findings and arrange the recurrence of oral care based on the patient’s condition. Mostly, unconscious patients require mouth care as frequently as each 1 to 2 hours.

Documentation

The last step is the documentation. Record the procedure, including the patient’s capacity to coordinate and whether suctioning was vital. Then, report any relevant observations, for example, the presence of a gag reflex, bleeding gums, ulcerations, dry mucosa, or crusts on the tongue. Moreover, keep in mind that it is necessary to report any unusual findings to the doctor or the nurse in charge.

References:

Why dental health is important.

https://www.marshfieldclinic.org/specialties/dental-care/dental-why-important

How to Give Mouth Care.

https://www.drugs.com/cg/how-to-give-mouth-care.html

Using Personal Protective Equipment (PPE).

https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html

Physiology, Gag Reflex.

https://www.ncbi.nlm.nih.gov/books/NBK554502/

Yankauer Suction Tip.

https://www.sciencedirect.com/topics/medicine-and-dentistry/yankauer-suction-tip