Performing Mouthwashes

A variety of mouthwash solutions are available on the market (see Table 3.1). Selection of mouthwash should be based on the following factors:

1 a thorough oral assessment
2 nurses’ knowledge base regarding the suitability of a particular solution for a client
3 clients’ preferences
4 individual prescription.

Preparation	Uses	Disadvantages
Sodium bicarbonate	Effective mucosolvent	Tastes unpleasant and can burn if not adequately diluted. Can also alter oral pH allowing bacteria to multiply
Glycerine and thymol	Initially refreshing but effect lasts only 20–30 seconds	Can over-stimulate the salivary glands leading to reflex action and exhaustion
Tap water	Refreshing, ideal pH and readily available	Short lasting and does not contain a bactericide
Chlorhexidine gluconate	Inhibits bacterial growth	Tastes unpleasant and stains teeth with prolonged use
Synthetic saliva	Provides moisture	Does not check bacterial growth
Pineapple cubes/juice	Refreshing, promotes saliva production and contains an enzyme that helps cleanse the mouth	Cannot be used for clients who are nil by mouth
Petroleum jelly/Lip balm	Can prevent cracked lips	Some clients do not like the feel or taste
Toothpaste	Effective for removing debris	Can dry the oral cavity if not adequately rinsed
Nystatin	Effective for fungal infections	Tastes unpleasant to some clients. Must be prescribed
Denture cleaner/Baking soda	Effective in removing stains	Can bleach dentures over time

It is important that the mouthwash solution is constituted according to the manufacturer’s instructions and its use is monitored and evaluated. Some solutions, such as chlorhexidine gluconate, are classed as medications and should therefore always be prescribed and administered in accordance with local drug administration policies.

In promoting cleanliness and comfort, clients may use or be encouraged to use other mouth care aids such as dental floss. Flossing helps remove plaque and tartar between the teeth and thus reduces the potential for gum inflammation and infection. Flossing can be performed prior to or following teeth cleansing. The procedures and rationales for flossing are given below.

Procedure	Rationale
Discuss with client their preferred technique	To gain co-operation and consent and to facilitate negotiation
Put on apron and wash hands. Wear gloves if performing procedure for client	Reduces risk of cross-infection. Reduces transmission of organisms
Remove a length of dental floss, wrap around both index fingers (either client or nurse), insert one end between teeth and gently slide up and down each side of every tooth	Avoids injury to the gums
Adjust floss between index fingers	To facilitate control
Continue until all teeth have been flossed. A fresh part of floss is used for each tooth	To reduce potential for cross-infection
Allow client to rinse after flossing	To remove residual debris and promote client comfort
Provide facilities for the client to wash their hands following the procedure	Infection control
Note condition of teeth and gums and refer as appropriate	To ensure care needs are met