Assisting individuals with oral hygiene

Oral hygiene may involve the use of a toothbrush and paste, a mouthwash or other mouth cleaning preparations, such as interdental sticks and floss, to achieve and maintain the cleanliness of the teeth or dentures, the gums, hard and soft palates and lips. It is considered an essential nursing procedure as an unkempt mouth can prove to be a serious health hazard over time for some individuals. Assessment and care of the oral cavity should therefore form part of a client’s daily hygiene routine, and efficacy of interventions should be continuously evaluated.

The functions of the mouth are:
• breathing
• speaking
• eating
• tasting
• drinking
• smiling
• kissing.

A healthy mouth should:
• be pink and moist, including the tongue, oral mucosa and gums
• have teeth/dentures that are clean and free of debris
• have adequate salivation
• have lips that are smooth and moist
• display no evidence of difficulties with eating or swallowing.

In order to deliver appropriate oral hygiene, it is recommended that an oral assessment tool be used to identify a client’s oral health status. The following are some of the specific points to consider when assessing an individual’s oral hygiene:

Example of an oral assessment tool

• Physical
fluid and dietary intake
medication – some drugs can alter oral hygiene needs, including antibiotics,
steroids, diuretics, drugs used in cytotoxic therapy, antihistamines, antispasmodics,
anticholinergics, psychotropics, antidepressants,
tranquillizers and opiates
client receiving oxygen therapy or oral suction
level of consciousness
immune status
physical disabilities, for example unable to move tongue from side to side,
unable to empty oral cavity when eating
health status; note particularly any renal impairment, diabetes or anaemia
does the client have a tracheostomy?
have they had a laryngectomy?
ability to self-care
surgery – oral, upper gastro-intestinal
manual dexterity
smoking
age
dentures/braces, full/partial, well fitting/ill fitting
condition of lips, mucous membranes, gums, hard and soft palates
(smooth/pink/moist/dry/cracked/ulcerated/bleeding)

• Psychological
confusion
disorientation
depression
level of self-esteem
perceptions of self

• Sociocultural
health benefits
values
dietary beliefs

• Environmental
availability of clean/running water supply
other resources, for example toothbrushes, toothpaste
privacy

• Politico-economic
limited finances for a healthy diet or resources