Performing oral hygiene

Performing oral hygiene can help to maintain healthy structures of the oral cavity, retain moisture, remove debris, prevent plaque and reduce the risk of infection, as well as adding to the client’s comfort and well-being. Clients should be encouraged to perform oral hygiene immediately after eating and more frequently if their health is compromised. Toothpaste, toothbrush and water are the cheapest, most reliable and most effective tools for mouth care, though a doctor, dentist or dental hygienist may sometimes recommend other products from time to time if a client’s oral hygiene is compromised (see Table 3.1). National standards for oral hygiene, and for personal hygiene, have been developed by the Department of Health.

The equipment needed consists of spatula/torch for oral inspection; disposable gloves and apron; solutions/cleaning agents/mouthwash (all solutions should be freshly prepared in accordance with manufacturers’ instructions); toothpaste, denture cleaners; paper towels; clinical waste bag; water (drinking); denture pot if required – labelled; Vaseline/soft white paraffin gel; towel or protective clothing; tissues for wiping the mouth; suction equipment (if needed); airway (if needed); and an oral toilet pack if needed (this may already contain paper towels, disposal bag). The procedures and rationales for performing oral hygiene are given below.

Procedure	Rationale
Offer a full explanation of the procedure, including client’s individual preferences	To gain consent, co-operation and participation in care
Ensure all equipment is at hand to administer care	To ensure effective use of time and resources
Apply apron, wash your hands and put on gloves	To prevent contamination with body fluids
Ensure privacy	To promote client dignity and self-esteem
Assist the client into a comfortable sitting position if possible	To promote client comfort and safety and to facilitate thorough oral inspection and assessment
Remove all appliances, e.g. dentures, and place in a labelled pot	To assist assessment of condition of the oral cavity
Using spatula and torch inspect oral cavity, including teeth, gums and mucosa. Note bleeding, ulcers, sores, food debris, condition of lips	Comprehensive assessment is essential to determine individual care needs
Place towel over client’s chest	To protect clothing
Using a soft toothbrush and fluoride toothpaste gently brush all teeth at an angle of 45o to the teeth and all other surfaces, i.e. gums, tongue, and oral tissues. NB When cleaning the tongue, avoid the posterior aspect as this can stimulate the gag reflex	Effective in dislodging debris and dental plaque from teeth and the gingival margin. Encourages tissue perfusion. Client comfort
If the client cannot tolerate a toothbrush a foam stick can be used, though these are less effective	Client safety. To prevent inhalation of fluid
Offer the client water or mouthwash and advise them not to swallow this. Provide a receiver for disposal. Protect the airway at all times. Suction equipment may be used to remove any excess	Reduce potential for infection. Client safety. To prevent inhalation of fluid
Provide wipes or tissues and assist client to wash/wipe and dry mouth	Client comfort and dignity
Apply lubricant to lips	Helps moisturize the lips and can reduce potential for cracking
Toothbrushes should be rinsed and dried after use	Prevents growth of micro-organisms
Tidy area and clear away equipment	Safety
Remove gloves, apron and wash hands	Prevents cross-infection
Record procedure, listing any improvement or deterioration in the condition of the client’s mouth	Legal requirement. Facilitates effective communication between health care staff

The frequency of this procedure should be based on regular oral cavity assessment and client preferences. In order to maintain a moist and healthy oral cavity clients should be encouraged to take frequent sips of fluids. Alternatively, soda water or ice cubes can be offered to freshen the mouth. Sucking on fresh fruit, if allowed, can also provide refreshment and helps stimulate saliva production, particularly pineapple.