Mouth care for a patient with natural teeth

Authors: V.Rednenko 

Editor: V.Rednenko 

Equipment for the practical skill:

• Simulated patient (patient manikin)
• Hospital bed with bedding
• Over-bed table
• Towels (Paper towels)
• Gloves
• Protective eyewear and a gown (optional; use if blood may splash or spray)
• Toothbrush
• Toothpaste
• Emesis basin
• Cup
• Floss pick or dental floss
• Mouthwash
• Lip balm or petroleum jelly and cotton-tipped applicator

Clinical situation:

Patient N. is in the neurological department with acute cerebrovascular accident, he is assigned to Brushing and Flossing a Person’s Teeth.  Carry out the prescribed procedure.

Order of the skill performance:

Preparatory stage:

• Introduce yourself
• Identify patient
• Obtain informed consent to the procedure (if the patient's condition allows it)
  • Give all the information to the person about what the procedure involves, including the benefits and risks, whether there are reasonable alternative, and what will happen without this procedure
  • Explain what you are going to do.
  • Ask the patient to consent to procedure.
  • Explain to the patient how he can help.
• Make sure you have the necessary equipment and put it on the over-bed table (the chair next to the bed)
• Sanitize your hands, put on gloves
• Prepare the patient bed:
• Raise the bed to a comfortable working height.
• Make sure the wheels on the bed are locked

Main stage:

• Cover the over-bed table with the paper towels and arrange your supplies. In the cup, prepare a solution of half water and half mouthwash.
• Position the person in high Fowler's position.
• Unfold the towel. Place it across the person’s chest.
• Put on the gloves and any other personal protective equipment.
• Give the person a mouthful of the mouthwash mixture to rinse his mouth. Hold the emesis basin under the person’s chin to catch the liquid.

• Dry the person’s mouth and chin using the towel.
• Wet the toothbrush by pouring mouthwash solution over it.
• Put toothpaste on the wet brush.
• Brush the upper teeth and gums:
  • Starting at the back of the mouth, place the toothbrush on the outer surface of the upper teeth at a 45-degree angle. Gently brush the outer surface of each tooth, using short back-and-forth (tooth-wide) strokes.

• Next, clean the chewing surfaces of the upper teeth, moving from one side of the mouth to the other and using the same short, back-and-forth strokes.

• Finally, put the brush vertically against the inside surfaces of the front upper teeth and brush with a gentle up-and-down motion.

• Brush the lower teeth and gums in the same way.
• Brush the tongue.
• Give the person a mouthful of the mouthwash mixture to rinse his mouth. Hold the emesis basin under the person’s chin to catch the liquid. Dry the person’s mouth and chin using the towel.
• Floss the person’s teeth.
  • Floss pick. Starting between the two front teeth, hold the handle of the fl oss pick and slide the floss carefully between the teeth. Hold the floss against the tooth and scrape the side of the tooth, moving the floss away from the gum. Repeat with the next tooth, moving from the front of the mouth to the back of the mouth on one side and then the other side. Then repeat for the lower teeth.
  • Dental floss. Break off about 18 inches of floss from the dispenser. Wrap most of the floss around the middle fingers of both hands, leaving 1 inch (2,5 cm) of floss between your hands. Stretch the floss tightly between your thumbs and index fingers.

• • Starting between the two front teeth, slide the fl oss carefully between the teeth. Hold the floss against the tooth and scrape the side of the tooth, moving the floss away from the gum. After you floss each tooth, unwrap a clean 1-inch section of floss from your finger and wrap the soiled floss around the other finger. Floss from the front of the mouth to the back of the mouth on one side and then the other side. Then repeat for the lower teeth.
• Give the person a mouthful of the mouthwash mixture to rinse his mouth. Hold the emesis basin under the person’s chin to catch the liquid.
• Dry the person’s mouth and chin with the towel, and place the towel in the linen hamper.
• Encourage the person to apply lip balm or petroleum jelly to the lips. Assist the person as needed.
• Remove and dispose of your gloves.

Final stage:

• Ensure the person’s comfort and good body alignment.
• Adjust equipment for safety: Lower the bed to the level specifi ed in the person’s care plan. Make sure the wheels on the bed are locked. Place the person’s method of calling for help within reach. Lower or raise the side rails according to the person’s care plan.
• Clean up your work area.
• Wash your hands.