Oral Hygiene. & Nursing Care. Barbara Farrimond CNS for Head & Neck Oncology 10 th April 2008

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1 Oral Hygiene & Nursing Care Barbara Farrimond CNS for Head & Neck Oncology 10 th April 2008

2 AIM: To provide guidance and information regarding the provision of oral hygiene for hospitalised patients

3 Objectives: To label the functions and structures of the oral cavity To discuss the importance of effective oral hygiene To list client groups who may require assistance with oral hygiene To recognise the need to individual patient assessment

4 Objectives: To recognise the need to individual patient assessment To discuss the methods/medication that support oral hygiene provision To state how to perform oral care/assessment To recognise some common symptoms associated with oral conditions

5

6 What Should a Healthy Mouth look like? Pink moist tongue, oral mucosa & gums Teeth/dentures clean and free from debris Well fitting dentures Adequate salivation Smooth moist lips No difficulties eating or swallowing

7 Initial breakdown of food products utilising teeth and saliva. Taste Communication/social interaction Breathing Functions of the Oral Cavity

8 The Important of Oral Care Oral Hygiene Communication Comfort Ease of oral intake General health Problems can be life threatening

9 Conditions/Treatments which increase patients risk of oral complications Treatments Conditions Diabetes Renal failure Malnutrition Dehydration Physical disability/unable/ unco operative Depression HIV/Immuno supressed patients Oxygen therapy Radiotherapy to the head & neck Intermittent suction Thurgood (1994)

10 Drug Treatments which increase patients risk of oral complications Drugs Antibiotics Phenytoin Diuretics Anti depressants Morphine

11 Objectives of oral care To maintain the oral mucosa and keep it clean soft moist and intact To keep natural teeth free from plaque To maintain denture hygiene and prevent denture induced disease

12 Objectives of oral care To prevent infection To prevent oral discomfort To encourage adequate nutritional intake To maintain the mouth in a state of normal function

13 How Can We as Nurses Help? Assessment is required, not only for those in obvious need of care, but where treatment is preventable Care should be evidence based, and tailored to meet the patients individual requirements Oral hygiene assessment tool

14 Physical Feature: Teeth / Dentures Mucous Membranes Lips Saliva Gums What do we Look for When Giving Oral Care Observe For: Plaque, debris or dental Caries or ill fitting dentures Coating, redness, ulceration Or bleeding Cracking, bleeding or ulceration Consistency & Quantity Redness, ulceration & bleeding

15 Toothbrush: Products to Support Oral Hygiene should be the first line of oral cleansing, as it effectively reduces plaque and gingivitis (Pearson et al 2002), and is proven to be more effective than foam swabs at removing plaque and cleaning approximal and crevice sites

16 Fluoride Toothpaste: Products to Support Oral Hygiene Recommended and recognised as the most effective and safest cleansing agent, fluoride reduces the incidence of dental caries and prevents cavities (Beck and Yasko 1993)

17 Products to Support Oral Hygiene Swabs: Use when tooth brushing not advisable Not as effective as tooth brushing, useful to remove debris, plaque, and for patient comfort

18 Products to Support Oral Hygiene Sodium Bicarbonate: appropriately diluted according to manufacturers instructions to dissolve viscous mucous and remove debris

19 Products to Support Oral Hygiene Pink Mouth Wash Tablets Glycerin Thymol This solution is useful for refreshing the mouth, but it has no therapeutic effect and is not antimicrobial (Heals D 1993).

20 Chlorhexidine corsodyl Products to Support Oral Hygiene Use under prescription to complement oral care procedure, has broad spectrum antibacterial and anti fungal activity, can aid prevention of plaque, caries and gingivitis prolonged use can alter taste perception and cause yellow/brown superficial stain.

21 Lip Care Lubricants such as petroleum jelly, and yellow paraffin are often recommended for lips (Caution with Oxygen therapy combustion) Moisturising cream is a good alternative Lip balms

22 Oral care agents/tools Water safest moisturising agent causing minimal disruption to the oral eco system (Gooch 1989) Tinned pineapple contains proteolytic enzyme which has a cleaning effect on the mouth (Rawlins 2001)

23 Dentures: Clean dentures with toothbrush and toothpaste at least once per day, ensure removal prior to oral assessment. Ensure container is cleaned and replaced weekly, and correctly labelled to identify owner.

24 How often do you perform mouth care? Literature search reveals no consensus Regularity should be related to the clients condition and his/her need. Assessment is essential to evaluate the care you are giving and the frequency required

25 Procedure Wash hands Gloves should be worn A good light/pen torch is essential to identify changes/establish a base line Tongue depressors help to see difficult areas hidden by the tongue If the patient wears dentures they should be removed prior to any oral assessment Oral hygiene packs

26 Oh..no the bit you ve all been waiting for Practical Session Divide yourselves into groups of 5, one volunteer required to undertake the mouth care, one group member to be in receipt of it, one to feedback regarding COMFORT & REFRESHMENT VALUE Group 1 Gloves, pink sponges, mouth wash Group 2 Gloves pink sponges, pineapple Group 3 Gloves gauze, forceps Group 4 Gloves gauze digital Group 5 Gloves toothbrush toothpaste

27 A rare sight!

28 Meths Mouth

29 My Department! Mouth cancer can affect the lips, tongue, cheeks and throat. Signs Treatment Precipitating factors

30 Tongue Cancer / Lip Cancer

31 Leukoplakia

32 Radiation Caries

33 Large apthous (mouth ulcer)

34 Pre and Post Treatment for Hairy Tongue

35 Cold Sores Herpes Simplex

36 Thrush (oral candiasis) after a course of steroids

37 Gingivitis

38 Useful Information ctiveguides/smilesaver.cvsp ndex.cvsp Fitzpatrick, Joanne (2000) Oral health care needs of dependent older people: responsibilities of nurses and care staff. Journal of Advanced Nursing. 32(6): Xavier, G (2000) The importance of mouth care in preventing infection. Nursing Standard. 14(18):47 52,

39 Thank you

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