Mouth care should be given to an unconscious person

Bowl for dentures
Tooth paste and brush
A sputum mug or receiver for used water
Mackintosh and towel
Napkin
Orange sticks
Mirror

1. Explain procedure to patient.
2. Arrange requirement for patient.
3. Assist patient into a suitable and comfortable position.
4. Places towel under chin for protection.
5. Give brush with paste/ chewing sponge /stick to him.
6. Encourage patient to brush the teeth.
7. Cleans the mouth thoroughly but gently inside the cheeks, both sides of gums, tongue and palate.
8. Give water or mouth wash and void content into a receiver.
9. Make patient comfortable in bed
10. Clears away used items
11. Washes and dries hands, records procedure and reports any abnormalities.

Two gallipots ( for mouth cleaning lotion and cotton wool or gauze )
Bottle containing the mouth cleaning lotion ( e.g. normal saline, sodium bicarbonate, weak strength of hydrogen peroxide, maxolon mouthwash)
Padded Spatula
Mouth gag
Artery, sponge or dressing forceps
Dissecting forceps
Bowl for dentures
Glycerine or Vaseline
Receiver for used swabs  Orange sticks (toothpick)

COMPONENT TASK

1. Explain procedure to patient and provide privacy
2. Prepare a tray and takes it to the patient’s bedside
3. Put patient in a suitable position
4. Protects patients’ gown and bed linen with mackintosh and towel.
5. Pour lotion into gallipots washes and dry hands.
6. Cleans lips and outer part of teeth. Opens mouth with padded spatula.
7. Inspect mouth for any abnormality and remove dentures.
8. Take swab with forceps dip into cleansing lotion and squeeze out excess.
9. Cleans mouth thoroughly but gently, i.e. from inside the cheeks, both sides of the gum,
tongue and palate changing swabs frequently.
10. Controls movement of the tongue with spatula.
11. Uses tooth pick to clean in between of teeth.
12. Cleans mouth with water or any mouth wash.
13. Cleans lips and applies Vaseline.
14. Make patient comfortable in bed and removes screen.
15. Discard tray, decontaminates, washes and sterilizes instruments.
16. Washes hands and documents procedures and findings.

1. Cullinan MP, Ford PJ, Seymour GJ. Periodontal disease and systemic health: current status. Australian Dental Journal. 2009;54(supplement 1):S62–S69. [PubMed] [Google Scholar]

2. Ford PJ, Raphael SL, Cullinan MP, Jenkins AJ, West MJ, Seymour GJ. Why should a doctor be interested in oral disease? Expert Review of Cardiovascular Therapy. 2010;8(10):1483–1493. [PubMed] [Google Scholar]

3. Gurenlian JR. Inflammation: the relationship between oral health and systemic disease. Dental Assistant. 2009;78(2):8–43. [PubMed] [Google Scholar]

4. Azarpazhooh A, Leake JL. Systematic review of the association between respiratory diseases and oral health. Journal of Periodontology. 2006;77(9):1465–1482. [PubMed] [Google Scholar]

5. Hutchins K, Karras G, Erwin J, Sullivan KL. Ventilator-associated pneumonia and oral care: a successful quality improvement project. American Journal of Infection Control. 2009;37(7):590–597. [PubMed] [Google Scholar]

6. Johnstone L, Spence D, Koziol-McClain J. Oral hygiene care in the pediatric intensive care unit: practice recommendations. Pediatric Nursing. 2010;36(2):85–97. [PubMed] [Google Scholar]

7. Han YW. Oral health and adverse pregnancy outcomes—what's next? Journal of Dental Research. 2011;90(3):289–293. [PMC free article] [PubMed] [Google Scholar]

8. Bakhshandeh S, Murtomaa H, Mofid R, Vehkalahti MM, Suomalainen K. Periodontal treatment needs of diabetic adults. Journal of Clinical Periodontology. 2007;34(1):53–57. [PubMed] [Google Scholar]

9. Borrell LN, Joseph SP. Periodontal treatment may control glycemic status among diabetic patients. Journal of Evidence-Based Dental Practice. 2011;11(2):92–94. [PubMed] [Google Scholar]

10. Teeuw WJ, Gerdes VEA, Loos BG. Effect of periodontal treatment on glycemic control of diabetic patients: a systematic review and meta-analysis. Diabetes Care. 2010;33(2):421–427. [PMC free article] [PubMed] [Google Scholar]

11. Kurihara N, Inoue Y, Iwai T, et al. Oral bacteria are a possible risk factor for valvular incompetence in primary varicose veins. European Journal of Vascular and Endovascular Surgery. 2007;34(1):102–106. [PubMed] [Google Scholar]

12. Padilha DMP, Hilgert JB, Hugo FN, Bos AJ, Ferrucci L. Number of teeth and mortality risk in the Baltimore Longitudinal Study of Aging. Journals of Gerontology. 2008;63(7):739–744. [PMC free article] [PubMed] [Google Scholar]

13. Jones JA, Fulmer T, Wetle T. Oral health content in nursing school curricula. Gerontology and Geriatrics Education. 1988;8(3-4):95–101. [PubMed] [Google Scholar]

14. Hein C, Schönwetter DJ, Iacopino AM. Inclusion of oral-systemic health in predoctoral/undergraduate curricula of pharmacy, nursing, and medical schools around the world: a preliminary study. Journal of Dental Education. 2011;75(9):1187–1199. [PubMed] [Google Scholar]

15. Institute of Medicine. Advancing Oral Health in America. Washington, DC, USA: The National Academies Press; 2011. [Google Scholar]

16. Berry AM, Davidson PM, Masters J, Rolls K. Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. American Journal of Critical Care. 2007;16(6):552–563. [PubMed] [Google Scholar]

17. Google Book Project at Penn State. http://www.libraries.psu.edu/psul/googlebooksproject/faq.html.

18. Oral health topics: dentures. http://www.ada.org/2648.aspx?currentTab=2.

19. Oral Health Topics: Cleaning Your Teeth & Gums. http://www.ada.org/2624.aspx?currentTab=2.

20. Chalmers J, Pearson A. Oral hygiene care for residents with dementia: a literature review. Journal of Advanced Nursing. 2005;52(4):410–419. [PubMed] [Google Scholar]

21. Chalmers JM, Pearson A. A systematic review of oral health assessment by nurses and carers for residents with dementia in residential care facilities. Special Care in Dentistry. 2005;25(5):227–233. [PubMed] [Google Scholar]

22. Chalmers J, Johnson V, Tang JH, Titler MG. Evidence-based protocol: oral hygiene care for functionally dependent and cognitively impaired older adults. Journal of Gerontological Nursing. 2004;30(11):5–12. [PubMed] [Google Scholar]

23. Chalmers JM. Behavior management and communication strategies for dental professionals when caring for patients with dementia. Special Care in Dentistry. 2000;20(4):147–154. [PubMed] [Google Scholar]

24. Clemmens DA, Kerr AR. Improving oral health in women:nurses' call to action. The American Journal of Maternal Child Nursing. 2008;33(1):10–16. [PubMed] [Google Scholar]

25. Fitch JA, Munro CL, Glass CA, Pellegrini JM. Oral care in the adult intensive care unit. American Journal of Critical Care. 1999;8(5):314–318. [PubMed] [Google Scholar]

26. Gil-Montoya JA, de Mello ALF, Cardenas CB, Lopez IG. Oral health protocol for the dependent institutionalized elderly. Geriatric Nursing. 2006;27(2):95–101. [PubMed] [Google Scholar]

27. Grap MJ, Munro CL, Ashtiani B, Bryant S. Oral care interventions in critical care: frequency and documentation. American Journal of Critical Care. 2003;12(2):113–118. [PubMed] [Google Scholar]

28. Jones DJ, Munro CL, Grap MJ, Kitten T, Edmond M. Oral care and bacteremia risk in mechanically ventilated adults. Heart and Lung. 2010;39(supplement 6):S57–S65. [PMC free article] [PubMed] [Google Scholar]

29. Jablonski RA. Examining oral health in nursing home residents and overcoming mouth care-resistive behaviors. Annals of Long-Term Care. 2010;18(1):21–26. [Google Scholar]

30. Jablonski RA, Munro CL, Grap MJ, Schubert CM, Ligon M, Spigelmyer P. Mouth care in nursing homes: knowledge, beliefs, and practices of nursing assistants. Geriatric Nursing. 2009;30(2):99–107. [PMC free article] [PubMed] [Google Scholar]

31. Jablonski RA, Swecker T, Munro C, Grap MJ, Ligon M. Measuring the oral health of nursing home elders. Clinical Nursing Research. 2009;18(3):200–217. [PubMed] [Google Scholar]

32. Munro CL, Grap MJ, Jablonski R, Boyle A. Oral health measurement in nursing research: state of the science. Biological Research for Nursing. 2006;8(1):35–42. [PMC free article] [PubMed] [Google Scholar]

33. Taylor CR, Lillis C, LeMone P, Lynn P. Fundamentals of Nursing: The Art and Science of Nursing Care. 6th edition. Philadelphia, Pa, USA: Lippincott Williams & Wilkins; 2008. [Google Scholar]

34. Wilkinson JM, Van Leuven K. Fundamentals of Nursing: Theory, Concepts, & Applications. Vol. 2. Philadelphia, Pa, USA: FA Davis; 2007. [Google Scholar]

35. Craven RF, Hirnle CJ. Fundamentals of Nursing: Human Health and Function. 6th edition. Philadelphia, Pa, USA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2009. [Google Scholar]

36. Delaune SC, Ladner PK. Fundamentals of Nursing: Standards and Practice. 3rd edition. New York, NY, USA: Thomson Delmar; 2006. [Google Scholar]

37. Potter PA, Perry AG. Fundamentals of Nursing. 7th edition. St. Louis, Mo, USA: Mosby Elsevier; 2009. [Google Scholar]

38. Lynn P. Taylor's Clinical Nursing Skills: A Nursing Process Approach. 2nd edition. Philadelphia, Pa, USA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008. [Google Scholar]

39. Wilkinson JM, Van Leuven K. Fundamentals of Nursing: Theory, Concepts, & Applications. Vol. 1. Philadephia, Pa, USA: FA Davis; 2007. [Google Scholar]

40. Jablonski RA, Therrien B, Mahoney EK, Kolanowski A, Gabello M, Brock A. An intervention to reduce care-resistant behavior in persons with dementia during oral hygiene: a pilot study. Special Care in Dentistry. 2011;31(3):77–87. [PubMed] [Google Scholar]

41. Institute of Medicine. Retooling for an Aging America: Building the Health Care Workforce. Washington, DC, USA: National Academy Press; 2008. [Google Scholar]

42. Felton D, Cooper L, Duqum I, et al. Evidence-based guidelines for the care and maintenance of complete dentures: a publication of the American college of Prosthodontists. Journal of Prosthodontics. 2011;20(supplement 1):S1–S12. [PubMed] [Google Scholar]

43. NYUCN Launches Oral Health Nursing Education Program. http://www.nyu.edu/about/news-publications/news/2011/04/26/nyucn-launches-oral-health-nursing-education-and-practice-program.html.

Page 2

Bibliographic data	Pages devoted to oral health and hhygiene	Total Pages*	Percent of oral health and hygiene content	Significant findings
				(i) Assessment was 0.25 page.
				(ii) Recommended cleaning dentures with soft-bristled toothbrush “because hard-bristled brushes can produce grooves in dentures” (page 722). Although this sentence is congruent with the American Dental Association guidelines [18, 19], it could be misconstrued as advising against using denture brushes, which tend to have firmer bristles than soft toothbrushes.
Craven and Hirnle [35]	4.5	1408	0.32%	(iii) Directed nursing student to use string floss, not floss heads or interdentate sticks.
				(iv) Suggested the use of a padded tongue blade oral to keep the mouth of an unconscious patient open.
				(v) Recommended either a soft toothbrush or foam swabs to brush teeth.
				(vi) Denture removal incongruent with published dental research.

				(i) Oral health assessment content did not address checking dentures for fit, integrity, or plaque.
				(ii) Recommended the use of foam swabs for “clients with impaired physical mobility or who are unconscious (comatose)” (page 759).
				(iii) No information on how to correctly floss or brush teeth, although the text provided a recipe for toothpaste: 2 parts salt and 1 part baking soda, no citations for this recipe.
				(iv) Recommended brushing dentures with toothpaste.
Delaune and Ladner [36]	8.5 with pictures	1391	0.61%	(v) Did not direct nurses to brush the bums of edentate patients with soft toothbrushes.
				(vi) Simultaneously recommended the use of foam sponges with toothpaste or toothbrushes with toothpaste.
				(vii) Confusing content in the area of flossing. For generic mouth care, solely advised the use of string floss for flossing. For patients who were comatose, directed the use of floss holders BUT also recommended against flossing teeth for patients fully dependent on nurses for care.
				(viii) Denture removal incongruent with published dental research.

				(i) Assessment content focused on the oral cavity (10 lines) but did not address normal versus abnormal findings.
				(ii) Included content specific to oral hygiene and persons with cognitive impairments consistent with published articles in this area by Chalmers [20–23].
				(iii) No mention of soft toothbrush, simply “toothbrush.”
				(iv) For assisting the patient, did recommend flossing, but technique was incorrect—recommended that the nurse use 6 inches of floss. Did recommend “a plastic floss holder” (page 338).
Lynn [38]	10	1042	0.96%	(v) Mouthwash is presented a simply a mechanism for “leaving a pleasant taste in the mouth” (page 338) instead as an adjuvant to prevent caries and gingivitis.
				(vi) Recommended use of a padded tongue blade to prop open the mouth of a “dependent” patient (page 341).
				(vii) For a dependent patient, recommended use of toothpaste and toothbrush.
				(viii) For a dependent patient, Remove dentures if present and use a foam swab or gauze-padded tongue blade “moistened with water or dilute mouthwash to gently clean gums, mucous membranes, and tongue.” (page 341).
				(ix) Denture removal incongruent with published dental research.
				(x) No direction about need to remove dentures overnight.
				(xi) Recommended toothpaste to brush dentures.


				(i) Out of all 7 textbooks, best description of oral health assessment (defined and described caries, periodontal disease, gingivitis; also addressed the components of an oral health assessment such as presence/absence of plaque quality of saliva and integrity of buccal mucosa).
				(ii) Oral-systemic link clearly articulated.
				(iii) Recommended brushing 4x/day.
				(iv) Stated that foam swabs) are ineffective and should not be used—but then, in procedure section, recommended foam swabs for unconscious or debilitated patients (page 889) and showed them in pictures.
Potter and Perry [37]	7.5	1408	0.53%	(v) Provided clearest instructions for oral care on an unconscious/mechanically ventilated patient.
				(vi) Recommended oral airway to keep mouth open for unconscious/debilitated patient.
				(vii) Foam swabs recommended for patients without teeth.
				(viii) Best description of oral health assessment, defined and described caries, periodontal disease, gingivitis.
				(ix) No mention of using toothpaste to clean dentures, but picture on page 891 shows toothpaste being used. (x) Denture removal and insertion directions simplistic too and incongruent with published dental research.
				(xi) No recommendation to use interdentate sticks or floss heads for flossing.

				(i) The oral health assessment was limited to 3 paragraphs in one health assessment chapter. There was no information on checking dentures for fit, integrity, or plaque. (ii) Provided overall correct mouth care techniques, including tongue brushing.
Taylor et al. [33]	4.75	1742	0.27%	(iii) Gave detailed directions for flossing using string floss; nothing about alternatives.
				(iv) For dependent patient, advised the use of padded tongue depressor to prop mouth open instead of a bite block.
				(v) Advised using toothpaste for dentures.
				(vi) No content on removing dentures from patient's mouth.
				(vii) Recommended mouth care every 1-2 hours, especially for persons who were not able to take anything by mouth.

				(i) Erroneously instructs patients in “Teaching Your Client About Oral Hygiene” to use regular toothpaste when brushing dentures.
Wilkinson and Leuven [39]	4.5	1089	0.41%	(ii) Also included a recipe for toothpaste, 1 part baking soda, 2 parts salt.
				(iii) Did not recommend removing and leaving dentures out overnight.

				(i) Included 3.3 pages about assessing the oral cavity; one of the most comprehensive.
				(ii) Included the use of foam swabs for mouth care, although the authors stated that toothbrushes better remove plaque and debris.
Wilkinson and Leuven [34]	11.3	1026	1.10%	(iii) Included content on the use of a floss holder.
				(iv) Recommended dilute hydrogen peroxide as a mouth wash.
				(v) Recommended toothpaste for cleaning dentures.
				(vi) Denture removal incongruent with published dental research.(vii) No indication for leaving dentures out overnight.
				(viii) For providing mouth care to an unconscious patient, recommended using a bite block or a padded tongue depressor.