What is the correct procedure when cleaning the teeth of an unconscious person?

Nurse Rita is receiving endorsement from the outgoing nurse and is reading the patient’s chart for orders. In one chart, she read that oral care is to be done before the end of the shift. Being employed in the hospital for almost a year now, she knows that oral care is done through:

Independent patients

• Patients who are able to sit in a Fowler’s or semi-Fowler’s position can usually perform their own oral hygiene as long as the necessary supplies are within easy reach.
• For independent patients, sitting on the edge of the bed or standing at the sink is also an option when performing oral hygiene.
• While a patient is performing oral hygiene, it is important for you to observe the process and provide any necessary teaching about brushing and flossing. This is also a good time to discuss the importance of oral hygiene and good oral health with the patient.

Dependent patients

• When patients become ill, have surgery, or have a medical condition that inhibits the use of their hands, you must perform oral hygiene for them.
• Before assuming dependent patients are incapable of performing any of their oral hygiene, be sure to assess their level of dependence and invite them to participate in any way they can.
• Be sure to add the level of assistance that is required to the patient’s plan of care. The healthcare team can then be aware of how and to what extent they have to assist the patient with oral care.

Unconscious patients

• An unconscious patient requires frequent and meticulous oral hygiene to prevent oral health problems from developing.
• Because these patients usually breathe through their mouth and are unable to take in anything by mouth, sordes can easily accumulate on the lips, teeth, and tongue causing additional health concerns.
• Because unconscious patients are at risk for aspirating during oral hygiene, you must always have suction set up at the bedside and ready to be used before you begin providing oral hygiene.
• Proper positioning can help reduce the risk of aspiration.
• For an unconscious patient, the best position is side-lying with the patient’s head turned toward you in either a semi-Fowler’s position or with the head of the bed flat. Placing the patient in one of these positions allows fluid and any oral secretions to collect in the dependent side of the mouth and drain out.
• Use a soft-bristled toothbrush and toothpaste to brush your patient’s teeth gently to remove any debris, then brush the patient’s tongue.
• Use a syringe and water to rinse the teeth and tongue.
• Then use foam swabs moistened with diluted hydrogen peroxide or other facility-approved solution to remove crusts and secretions from the mucous membranes of the mouth.
• Be sure to suction any oral secretions that pool in the patient’s mouth during the procedure.
• Since an unconscious patient cannot report any mouth pain or discomfort, perform a thorough assessment of the oral cavity each time you provide oral hygiene.
• If you note any inflammation, infection, sores, or bleeding, initiate treatment immediately since oral health can affect the patient’s overall health status.

Source:

http://www.atitesting.com/ati_next_gen/skillsmodules/content/personal-hygiene/equipment/oral-hygiene2.html

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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