BACKGROUND

A.  Oral hygiene is directly linked with systemic infections, cardiac disease, cerebrovascular accident, acute myocardial infarction, glucose control in diabetes, nutritional intake, comfort, ability to speak, and the patient’s self-esteem and overall well-being.

B.  Definitions

1. Oral refers to the mouth (natural teeth, gingival and supporting tissues, hard and soft palate, mucosal lining of the mouth and throat, tongue, salivary glands, chewing muscles, upper and lower jaw, and lips).
2. Oral cavity includes cheeks, as well as hard and soft palate.
3. Oral hygiene is the prevention of plaque-related disease, the destruction of plaque through the mechanical action of tooth brushing and flossing, or the use of other oral hygiene aids.
4. Edentulous means that natural teeth have been removed.

PARAMETERS OF ASSESSMENT

A.  The RN conducts an oral assessment or evaluation on admission and on every shift. The nurse assesses the condition of:

1. The oral cavity; should be pink, moist, and intact
2. The presence of or absence of natural teeth and/or dentures
3. Ability to function with or without natural teeth and/or dentures
4. The patient’s ability to speak, chew, or swallow
5. Any abnormal findings, such as dryness, swelling, sores, ulcers, bleeding, white patches, broken or decayed teeth, halitosis, ill-fitting dentures, difficulty swallowing, signs of aspiration, and pain

B.  Assessment tool: The Kayser-Jones BOHSE. See the “Resources” section for access to this tool.

IV. NURSING CARE STRATEGIES

A.  Oral hygiene plan of care: dependent mouth care of the edentulous patient

1. Oral care is provided during morning care, evening care, and as needed.
2. Wash hands and don gloves.
3. Remove dentures.
4. Brush dentures with toothbrush/toothpaste and rinse.
5. Brush patient’s tongue.
6. Reinsert dentures.
7. Apply lip moisturizer.

B.  Dependent mouth care: patients with teeth or partial dentures

1. Oral care is provided during morning care, evening care, and as needed.
2. Wash hands and don gloves.
3. Gently brush teeth in an up-and-down motion with short strokes using the toothbrush.
4. Brush patient’s tongue.
5. Apply lip moisturizer.

C.  For partial dentures, follow procedure for full denture cleaning and insertion.

D.  Assisted or supervised care

1. Oral care is provided during morning care, evening care, and as needed.
2. Assess what patient can do and provide assistance as needed.
3. Set up necessary items.

V. EVALUATION OF EXPECTED OUTCOMES

A.  Patient will:

1. Receive oral hygiene a minimum of once every 8 hours while in the acute care, long-term care, or home care setting.
2. Patients and families will be referred to dental services for follow-up treatment.
3. Patients and families will be educated on the importance of good oral hygiene and follow-up dental services.

B.  RN will:

1. Conduct an assessment or evaluation of the oral cavity on admission and every shift.
2. Notify the physician of any abnormalities present in the oral cavity.
3. Assess what each patient can do independently.
4. Observe aspiration precautions while providing care.
5. Provide oral care education to patients and families.

C.  Institution will:

1. Provide access to dental services as appropriate.
2. Provide ongoing education to healthcare providers.
3. Provide a yearly oral health and dental care in-service to healthcare providers.

ABBREVIATION

BOHSE       Brief Oral Health Status Examination

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Updated: November 2020

Boltz PhD, RN, GNP-BC, FGSA, FAAN, M., Capezuti PhD, RN, FAAN, E., Zwicker DrNP, APRN, BC, D., & Fulmer PhD, RN, FAAN, T. T. (2020). Evidence-Based Geriatric Nursing Protocols for Best Practice (6th ed.). Springer Publishing. Retrieved November 4, 2020, from https://www.springerpub.com/evidence-based-geriatric-nursing-protocols-for-best-practice-9780826188144.html#description

Chapter 11:  O’Connor, L. (2021) Oral Healthcare in the Older Adult.  In M. Boltz, E. Capezuti, D. Zwicker & T. Fulmer (eds.).  Evidence-Based Geriatric Nursing Protocols for Best Practice (6th ed. pp 149-155).  New York: Springer.