Mouth Care Guidelines
DEPARTMENT OF CRITICAL CARECLINICAL GUIDELINEMouth Care v1Mouth Care GuidelinesAIM: To provide guidance on the management of oral hygieneSCOPE: All adult ICUs within Brighton and Sussex University Hospitals1. INTRODUCTIONEffective oral hygiene practices (mouth care) are necessary to ensure themaintenance of effective oral health through the removal of bacterial plaque, drymouth care and denture care. Good oral health is important for eating, drinking,communication, the absence of pain and infection, and paramount for dignity andcomfort. Evidence suggests that poor oral health contributes to systemic diseasesincluding cardiovascular disease, diabetes and hospital acquired pneumonia(Winning et al., 2015).Research has shown that hospitalisation is associated with deterioration in oralhealth, and this in turn may lead to hospital acquired infections, poor nutritionalintake, increased pain & discomfort, longer hospital stays and increased care costs(Terezakis et al., 2011).Promoting and supporting patients with regular effective mouth care can improvepatients’ overall health and wellbeing (Locker et al., 2002).Date: April 2021 v1Revision Date: April 2024Authors: KH
DEPARTMENT OF CRITICAL CARECLINICAL GUIDELINEMouth Care v12. ASSESSMENTMOUTH CARE SCREENING TOOLINITIAL ASSESSMENT TO BE COMPLETED WITHIN 12 HOURS OF ADMISSIONTO CRITICAL CARE FOR ALL PATIENTS1. Does the patient have?YESNOPROVIDEDAT HOMEN/AToothbrushToothpasteUpper dentureLower dentureNameddenture potNo teethIF THE PATIENT HAS DENTURES PLACE THE SUNFLOWER SIGN AT THEBEDSIDE.EXPLAIN PROCEDURE TO THE PATIENT AND OBTAIN CONSENTGATHER EQUIPMENT REQUIRED: Pen torch / light source Tongue depressor Toothbrush / suction toothbrush Non foaming toothpaste Dry mouth gel Yankeur sucker / soft suction wand Mouthease cleansing sticks PPE Working suctionFOLLOW INFECTION CONTROL GUIDELINESWASH HANDS & PUT ON PPEDate: April 2021 v1Revision Date: April 2024Authors: KH
DEPARTMENT OF CRITICAL CARECLINICAL GUIDELINEMouth Care v1Following the daily care assessment and recording tool, complete theassessment of the following at least once per shift:LOW RISKMEDIUM RISKHIGH RISKBREATHINGSelf ventilating –room airOxygen maskVentilated (ETT orTracheostomy)LIPSPink & moistDry/cracked/difficultyopening mouthSwollen / ulceratedTONGUEPink & moistDry / fissured / shinyLooks abnormal /white coating / verysore or ulcerated.TEETH & GUMSClean / unbrokenUnclean / broken teeth /inflamed gumsSevere pain / facialswellingCHEEKS / PALATE /UNDER TONGUEClean / healthyDry mouth / food debris/ ulcerationVery dry / painfulWidespreadulceration / looksabnormalSALIVAPresent / thin /clearSticky secretionsThick / purulentsecretions.DENTURESClean /comfortableUnclean / looseLost / broken &unable to wear.Medium and High risk patients require more frequent mouthcareDate: April 2021 v1Revision Date: April 2024Authors: KH
DEPARTMENT OF CRITICAL CARECLINICAL GUIDELINEMouth Care v13. PROCESSRecommendation (Action)Justification (Rationale)1. Put on PPEHand HygieneReduce risk of infection / crosscontamination. Requirement of the BSUHInfection Control Policy.2. Using a paediatric toothbrush & a peasize amount of the non foaming ultramild toothpaste, brush the patient’steeth in a circular motion, ensuring youbrush behind the teeth & along thegum line. This should be done atleast 12 hourly.A paediatric toothbrush has softerbristles for Critical Care patients whomay have clotting disorders /sensitive gums. A toothbrush is alsothe ONLY tool demonstrated toeffectively remove dental plaque.3. Do not rinse the toothpaste out fromthe mouth.Rinsing with water straight aftertooth-brushing will wash away theconcentrated fluoride in theremaining toothpaste. This dilutes itand reduces its preventative effects.IMPORTANT – Some toothpastese.g. Oralieve, contain milk proteinsand are not suitable for patientswith a confirmed milk allergy orthose who are vegan.4. In patients with severe gum disease or The use of a toothbrush mayclotting disorders or following maxillo- exacerbate damage or bleeding.facial surgery, the use of foam swabsto provide mouth care is appropriate.5. Using the mouthease sticks removeDry secretions can cause discomfortany dry secretions from the palate &for the patient and interfere withoral mucosa. Mouthease sticks can be swallowing.used for 24 hours and are singlepatient use.6. Using the suction wand, suction oralsecretionsTo prevent the build up of oralsecretions that may contain VAPcausing pathogens.7. Dispose of the suction wand in theclinical wasteAll suction equipment is single use,as per BSUH Trust Policy.Date: April 2021 v1Revision Date: April 2024Authors: KH
DEPARTMENT OF CRITICAL CARECLINICAL GUIDELINEMouth Care v1Recommendation (Action)Justification (Rationale)8. For ventilated patients & those notable to eat and / or drink, provide drymouth care with 2 – 3 hourlyapplication of dry mouth gel to themouth & lips (if required).To provide comfort & reduce the riskof damage to the oral mucosa.9. Apply a water soluble lip moisturiser(e.g. Oralieve moisturising mouthgel) to the lipsOrally intubated patients havedifficulty re moistening their lips,resulting in dryness & cracking whichprovides a site for bacterialcolonisation.10. The toothbrush should be rinsedthoroughly after use and placed in aprotective cover.If your patient has oral thrush /candida the toothbrush should bereplaced after each use.To reduce the risk of bacterialcontamination.11. Remove all PPE and dispose of inclinical waste.12. Wash hands thoroughly using thecorrect methodReduces the risk of bacterialcontamination.13. Document actions on the CIS underthe hygiene section.14. Report any inflammation, ulceration,pain or signs of infection to themedical team.May need to consider increasing thefrequency of oral care or additionaltreatment / analgesia / antibiotics.THE USE OF ET TAPES MAY INCREASE THE RISK OF PRESSUREDAMAGE TO THE SURROUNDING SKIN.Unless contraindicated, and ANCHORFAST ET tube holder should be appliedif the patient is predicted to be ventilated for longer than 6 hours.IF YOU HAVE ANY CONCERNS ABOUT A PATIENT’S MOUTH OR NEEDFURTHER GUIDANCE, PLEASE SPEAK TO THE NURSE IN CHARGE ORTHE MOUTH CARE LINK NURSE FOR CRITICAL CARE (Kate Hirsch).Date: April 2021 v1Revision Date: April 2024Authors: KH
DEPARTMENT OF CRITICAL CARECLINICAL GUIDELINEMouth Care v14. DENTURES Patients with dentures require regular mouth care. Rinse dentures after meal times to avoid left over food debris sticking. Clean dentures with water & foamy soap over a bowl to reduce risk ofbreakage. Ensure dentures are kept safe whilst the patient is in hospital as they arecrucial for the patient’s dignity and ability to eat and drink. If the patient wears dentures when oral thrush is suspected, dentures mustbe removed and soaked in 0.2% chlorhexidine solution twice daily for 15minutes. The patient should be advised to leave their dentures out whilstthe mouth heals. Place the dentures in a named pot to keep safe.5. REFERENCESBrighton & Sussex University Hospitals Mouth Care for Adults Patient Policy(V1). 2017.Hua, F., Xie, H., Worthington, H.V., Furness, S., Zhang, Q., Li, C. 2017. OralHygiene care for critically ill patients to prevent ventilator – associatedpneumonia (Review). Cochrane Database of Systematic Reviews. 10. Articlenumber: CD008367.Locker, D., Matear, D., Stephens, M., Jokovic, A. 2002. Oral health – relatedquality of life of a population of medically compromised elderly people.Community Dental Health; 19 (2): 90 – 97.Terezakis, E., Needleman, I., Kumar, N., Moles, D., Agudo, E. 2011. Theimpact of hospitalisation on oral health: a systematic review. Journal of ClinicalPeriodontology; 38 (7): 628 – 636.Date: April 2021 v1Revision Date: April 2024Authors: KH
DEPARTMENT OF CRITICAL CARECLINICAL GUIDELINEMouth Care v1Winning, L., Linden, G.J. 2015. Periodontitis and systemic disease. Nature(BDJ team); Article number 15163.These guidelines also incorporate BSUH Trust Policies: IC002 InfectionPrevention Standard Principles Policy & IC003 Hand Hygiene Policy5. ONLINE RESOURESThe use of this guideline is subject to professional judgement and accountability. This guideline has beenprepared carefully and in good faith for use within the Department of Critical Care at Brighton and SussexUniversity Hospitals. The decision to implement this guideline is at the discretion of the on-call criticalcare consultant in conjunction with appropriate critical care medical / nursing staff.Date: April 2021 v1Revision Date: April 2024Authors: KH
Toothbrush / suction toothbrush Non foaming toothpaste Dry mouth gel . size amount of the non foaming ultra mild toothpaste, brush the patient’s teeth in a circular motion, ensuring you . Rinse dentures
A guide for health care professionals 1 Introduction6 1.1 What is Mouth Care Matters in hospitals? 7 1.2he Mouth Care Matters training programme T 8 1.3 Who is Mouth Care Matters training for? 8 1.4 Mouth Care Matters team 8 2 Why do we need Mouth Care Matters training? 10 2.1 What is the impact of hospitalisation on oral health? 11 2.2 We are a changing population 11 2.3 Our mouths are .
Mouth Care for Adult Patients in Hospital / Vers 5 (07/13) gum disease are almost entirely preventable and providing effective daily mouth care can help. Part two will focus on mouth care for more complex patients. Improving the oral health of adults in hospital is a key priority of Fundamentals of Care (WG 2003, standard 10).
Some fish have a mouth that is sword-shaped. The top jaw of the mouth has evolved into the shape of a long sword that protrudes from the front of the fish. Other fish have beak-shaped mouths. The triggerfish has a beak-like mouth. Having a mouth this shape makes it easy for the fish to break off small pieces of coral. The size of the mouth is .
starts once food enters the mouth The mouth receives food, tastes it and prepares it for The oesophagus ensures the smooth transit of a food bolus from the mouth to the . Sugar-free chewing gum can protect the teeth as it encourages saliva produc-tion, which reduces acidity in the mouth.
Integrated oral disease prevention and management: modules for primary health care workers. Good health begins with a healthy mouth. Module I: children 0-5 years old. 2nd edition. Washington, DC : PAHO, 2013. 1. Oral Health. 2. Mouth Diseases. 3. Preventive Dentistry. 4. Health Education - methods. 5. Dental Care. I. Title. ISBN 978-92-75-11794-1
Cervitec Plus - protective varnish Cervitec Gel - oral care gel Cervitec Liquid - mouth rinse Protective varnish, oral care gel and mouth rinse A high number of certain bacteria in the mouth will compromise the health of teeth, gums and the oral mucous membrane. Apart from these tissues, implants, dentures and dental restora-
lthough meticulous oral care has been shown to reduce the risk of ventilator-associated pneumonia (VAP), oral care practices among critical care nurses remain inconsistent, with mouth care often perceived as a comfort measure rather than as a critical component of infection contro
Guidelines Heuristics (rules that are generally true) –have been developed for various manufacturing technologies. Some DFM guidelines –Guidelines for machining –Guidelines for assembly –Guidelines for injection molding –Guidelines for sheet metal processing –Guidelines for sheet die forming –Guidelines for casting
