Explanation
Prior to performing oral care, we first need to gather the relevant information on the patient: Systemic condition (primary disease, disablity, consciousness, respiratory condition, nutrition, medications, posture, severity of dysphagia) Oral condition (extent of mouth opening, number of teeth, occlusion, artificial teeth (dentures), pain, tooth decay, swelling or reddening of the gums, halitosis, oral dryness (xerostomia), tongue coating, sensation for touch or taste, jaw jerk reflex, range of tongue movement, etc.).
Explanation
Before performing oral care, prepare items including cleaning equipment (toothbrush, interdental brush, tongue brush, sponge brush, etc.), suction (maximum suction pressure 20 kPa [150 mmHg] when suctioning the trachea), SpO2 monitor, oral speculum, gloves, gauze or tissues, forceps, dental mirror, cups, basin for gargling, towel, mouthwash, toothpaste, and oral moisturizers.
Explanation
When performing oral care various risks associated with oral care such as systemic effects on the respiratory and circulatory systems3, 4 should be considered . Also, many dysphagia patients can't swallow their saliva. Improper oral care can increase the risk of aspiration pneumonia due to aspiration and asphyxia following accidental ingestion of oral care tools. When oral care is not carried out thoroughly, patients are at greater risk of contracting periodontal disease or developing gingivitis and are prone to bleeding during oral care. Patients who have a bleeding tendency due to taking anticoagulants or having decreased liver function, or patients who have dry oral mucosa, are even more prone to bleeding during oral care and hemostasis becomes more difficult. So, before providing oral care, obtain the relevant information and prepare to manage any events that may occur.
Explanation
Toothbrushes is sellected by the age of the patient and condition of the oral cavity. Choose soft-bristle brushes for elderly people with periodontal disease. A narrow brush head covering about 1.5 to 2 molars is fine. Avoid animal-hair toothbrushes because they are difficult to dry and provide a fertile ground for bacteria to grow. When the patient has a weak grip, choose easy holding toothbrushes with a thick handle.
Explanation
Toothbrushes should be changed when the bristles are damaged or out of shape because this reduces their cleaning ability. Toothbrushes should be changed about once a month if they are used 3 times a day. To take sufficient care of toothbrushes after use, they should be thoroughly cleaned in water and dried well. Store them with the bristles at the top and in well-ventilated place.
Explanation
There are a number of ways to brush the teeth, but here we discuss two procedures that should be effective for cleaning the teeth. The scrubbing method involves using the toothbrush with the bristles perpendicular (90º) to the surface of the teeth, polishing the sides with repeated short movements. The bathing method involves using the toothbrush with the bristles at 45º to the teeth, concentrating the bristle tips on the gaps between the teeth, and then using light horizontal vibrating motions for tooth polishing. Both these methods involve applying the toothbrush with a force of about 150-200 g. toothbrush is held lightly as holding a pencil to avoid the excessive force, and moves small (1-2 mm width).
Explanation
Some techniques on the brushing method are useful according to the brushing area. For the molar region, use small brushing movements with the top of the brush head. For the premolar region, use small brushing movements with the lower end of the brush head. The toothbrush may need to be held vertically to brush the inside of the front teeth with scraping-like motions.
Explanation
Some techniques on the brushing method are useful according to the brushing area. For the molar region, use small brushing movements with the top of the brush head. For the premolar region, use small brushing movements with the lower end of the brush head. The toothbrush may need to be held vertically to brush the inside of the front teeth with scraping-like motions.
Explanation
Brushing with an electric toothbrush involves applying the bristles lightly to the teeth and polishing in one place for several seconds, before moving the toothbrush gently onto the next place. Constantly change the angle of the bristles when moving the toothbrush along the boundary between the teeth and gum. We need to be careful not to apply the brush too hard or clean for too long in one place, because this can cause injury to the teeth and gum. Many people think that less cleaning time is needed with an electric toothbrush because it is constantly moving, but this is not correct-the time required is the same as that with a normal toothbrush.
Explanation
Gargling involves cleaning with water and with chemical solutions (mouthwashes), and gargling is effective at maintaining good oral hygiene and preventing diseases of the oral mucosa or post-surgical infection. Mouthwashes alone will not remove plaque-brushing is also needed. However, mouthwashes are effective after toothbrushing to prevent the build-up of plaque. Major mouthwash ingredients include benzethonium chloride, povidone-iodine, azulene sulfonate sodium, and chlorhexidine gluconate.
Explanation
Interdental brushes are suited to cleaning the triangular spaces between teeth and between the teeth and gums. They are applied moving in and out of the gaps as we work our way along the teeth. There are various types of handles designed for interdental brushes, so we should choose a type that the user finds easy to use. Selecting a brush that does not fit the space between teeth can damage the gums, so care should be taken when choosing interdental brushes.
In deciding how often to replace interdental brushes, change them promptly if the bristles start to spread outward as in the case with toothbrushes. The brush handle can sometimes get cracked or broken, so care should be taken.
Explanation
Dental floss is suited to cleaning out any build-up between teeth, and it allows for cleaning in places that the bristles of a normal toothbrush can't reach. To use floss, cut a section of floss about 40 cm long (from the fingertip to the elbow) and while sliding the floss diagonally between teeth, move it back and forth to gently insert it as far as the gingival sulcus. Move the floss up and down along the teeth surfaces a number of times, to clean the lateral surfaces of the teeth. After cleaning, gently remove the floss. Floss is difficult to use if the mouth cannot be kept open.
Explanation
Toothpastes can be effective in different ways depending on their ingredients, which can have remineralization, anti-inflammatory, polishing, caries-preventing, hypersensitivity-relieving, and moisturizing properties. When choosing toothpaste, choose one with an ingredient that is expected to have the necessary effect, considering the condition of the patient's oral cavity. Initial choices may include a high-concentration fluoride-containing toothpaste (fluorine concentration is 1450 ppm) for patients with widespread tooth decay, a toothpaste with germicidal ingredients for patients with periodontal disease, or toothpaste for hypersensitivity. Apply toothpaste in small amounts to the bristles of the brush because the oral cavity could otherwise fill with foam. When the patients can't rinse their mouth and spit, choose a toothpaste that doesn't need to be washed out, and end by collecting any build-up with gauze.
Explanation
Dentures must be placed and removed in an appropriate way to avoid injuring the mucosa or breaking the artificial teeth, so care must be taken; ensure the oral cavity is clean, use the fingers or nails, attach the denture firmly using the fingers, hold the clasp (spring portion) to remove the denture, etc. Don't insert dentures by biting down not to damage the denture. Partial dentures need particularly careful cleaning because teeth with a clasp tend to be dirty. When clasps are on both sides, remove them both in parallel so that the clasps don't become misshapen.
Explanation
If dentures are not cleaned properly, they can become reservoirs for microbes. Dentures should be removed after each meal and before sleeping and cleaned using a denture brush or an old toothbrush. Care should to be taken to avoid dropping them during cleaning to avoid damaging them. It is advisable to use denture cleaner; however, avoid using polishing agents because they cause fine cracks in the surface of the artificial teeth in which bacteria will proliferate. Particular attention is needed for the clasps because they tend to have build-up. When not being used, dentures should be stored in water to prevent cracks and loss of shape due to desiccation.
References
- Yoneyama T., Yoshida M., Matsui T. and et al.: Oral care and Pneumonia. Lancet, 354:515,1999
- Suzuki M.: Dental Treatment Improves the Activities of Daily Living of the Disabled Elderly - A Stratified Randomized Controlled Trial (in Japanese) Japanese Journal of Gerodontology, 22: 265-287, 2007
- Shibata J., Miyatake K., Naganawa Y., et al, How to think the risk management of oral hygiene (in Japanese). The Journal of Dental Hygiene, 27:714-721, 2007.
- Fujii W. Points for oral hygiene (in Japanese). Rehabilitation nurse, 2:212-213, 2009.
- Japanese Society for Oral Health. Society's proposal of oral self care for eldery (in Japanese). J dent Hlth, 67:94-117, 2017.
Recommended readings
- Ueda K: Oral Care for Stroke Patients 2nd, Ishiyaku Pub. Inc. Tokyo, 2015.
- Haruyama F，Tsukamoto A，Sakamoto M: Technique of Oral Care for Nursing．Ishiyaku Pub. Inc. Tokyo, 2008.
- Nunomiya S & Moro E: Basics and techniques of Suction of Sputum for medical staff. Gakken Medical Shujunsha，Tokyo，2010.
- Japan Dental Association Eds: Oral Care based on EBM. Ishiyaku Pub. Inc. Tokyo，2002.
