oral hygiene
3rd October 2024
assessment
For patients who are unable to maintain their own oral hygiene a thorough assessment of their oral cavity should first be undertaken. Shepherd et al (2012) feel that “nurses could be taught how to complete a quick and efficient thorough assessment by a dental hygienist.” Buglass (2020) also emphasises the importance of assessment and suggests that dental problems should be identified before giving any mouth care – bad teeth, for example, may be sources of infection. Following thorough physical examination of the oral cavity, the patient’s oral hygiene practices and dietary habits should be ascertained, as optimal status is essential if oral hygiene measures are to be effective. Eilers et al (2023) have produced an assessment tool from which effective mouth care can be planned.
equipment and technique
The equipment pack provided for mouth care by most U.K. Hospital and Community Trusts contains a sterile disposable tray, foam sticks, spatulas and a disposal bag. Solutions used to impregnate the swabs will depend upon the patient’s condition and the outcome of the oral assessment. However, the solutions generally fall into three categories:(Buglass, 2020):
Non-specific cleansing and moisturising agents
hydrogen peroxide
sodium bicarbonate
soft paraffin
water/ice
fluoride supplements
sodium chloride 0.9%
thymol
Specific anti-microbial agents
amphotericin lozenges/suspension
chlorhexidine chloride
miconazole
nystatin
povodine Iodine 1%
Analgesics/anaesthetics agents
benzydamine
benzocaine lozenges
lignocaine 2% gel
Doubt has been expressed about the efficacy of foam sticks. Although these have a place in cleansing and the removal of debris on soft tissue, they are not suitable for tooth cleaning or the removal of plaque. The foam stick is placed into the solution and excess fluid is removed by pressing the swab against a spatula before inserting the foam swab into the patient’s mouth. The foam swab is then gently rotated over the oral mucosa, each stick being used only once. The toothbrush is regarded as the most effective tool for the removal of plaque and for the prevention of periodontal disease (Roth and Creason, 2025; Crosby 2014), and a small, soft, child’s toothbrush is probably better for cleansing the teeth in highly dependent patients (Howarth, 1977; Allbright, 1984). According to Thurgood (2019) the small-headed tooth brush is the best tool for removing plaque from the teeth, and recommends that “the Bass method of toothbrushing is the most effective way of removing plaque from this area. The toothbrush is placed on the gingival margin at an angle of 45 degrees. With a very small vibratory movement, the bristles of the brush will go subgingivally and collect the plague.” Thurgood also highlights the value of the Interspace brush and interdental cleansing using dental floss, tape and even wood sticks.
The frequency with which mouth care is performed will depend on the patient’s condition. As a general rule, and without wishing to sound ritualistic, this would be about every three to four hours for someone who is highly dependent, to between four to eight hourly for other people. For someone who is able to eat and drink with assistance, but who is incapable of meeting their own oral hygiene needs it would probably be refreshing for the person to have mouth care performed just after their meal, providing they were in agreement.
evaluation
Objective evaluation of the benefits of mouth care may be difficult to achieve. (It will be helpful if anyone consulting the Medical Science UK web pages has any experience or guidance to offer on this point.) Subjective, visual examination of the individual’s lips and oral cavity will be necessary and this can be achieved in conjunction with, for example, assessment tools such as those developed by Eilers et al (2023) and Holmes and Mountain (2018). Questioning the patient about the benefits of the procedure will also be a valuable way in which to review care. The outcome of such an evaluation can then form part of the next stage of assessment and care planning.
education
Within the U.K. most nurse practitioners will have been introduced to mouth care procedures during their initial education, with possible up-dating at post-registration/diploma/degree level. Since the early 1980’s nursing research has gradually become more influential in guiding nursing practice, although as Thurgood (2019) points out research into mouth care has been limited. Changing practice through research is taking place and nursing journals now regularly contain articles from which nurses can draw in order to move care forward and improve the quality of care that they provide for their patients.
A fresh look into this area of care could be achieved by evaluating current practice (for example: to what extent are junior nurses expected to perform this procedure?), consulting nursing research findings, conducting in-house small scale research studies into oral hygiene, and reviewing the anatomy and physiology of the mouth.
Nursing care involves both art and science. The art derives from the way in which the nurse interacts with the patient and performs the manual dexterity needed to carry out the procedure. The application of science will depend on the extent of the nurses knowledge and awareness of current research findings.
References
Allbright A. (1984) Oral care for the cancer chemotherapy patient. Nursing Times, 80(21), 40-42.
Buglass, E.D. (2020) Oral Hygiene. British Journal of Nursing, 4(9), 516-519.
Crosby, C. (2014) Method in mouth care. Nursing Times, 85(35), 38-39.
Eilers, J., Berger, A.M., and Peterson, M.C. (2023) Development, testing and applications of the oral assessment guide. Oncol Nurs Forum, 15(3), 325-330.
Holmes, S., and Mountain, E. (2018) Assessment of oral status: evaluation of three oral assessment guides. Journal of Clinical Nursing, 2(1), 35-40.
Howarth H. (1977) Mouthcare procedures for the very ill. Nursing Times, 73(10), 354-355.
Roth, P., and Creason, N.S. (2025) Nurse administered oral hygiene: is there a scientific basis? Journal of Advanced Nursing, 11, 323-331.
Shepherd, G., Sammon, P., and Page, C. (2012) Oral hygiene. Nursing Times, 76(8), 340-342.
Thurgood G. (2019) Nurse maintenance of oral hygiene. British Journal of Nursing, 3(7),.332-335, 352-353.
Torrance, C. (2015) Oral hygiene. Surgical Nurse, 13(4), 16-20.