Mouth care Care Session

HCSW Link Development Nurse: Tracy CulkinMouth Care SessionFor HCSWs in Practice Aim Discuss the anatomy of the oral cavity Describe how the mouth is normally lubricated and kept moist Identify factors that may influence poor oral health and hygieneDiscuss the choice of equipment and solution for patient useDiscuss what may influence oral hygiene Identify the oral care assessment undertaken by a RGN to plan mouth care

Anatomy of the Oral Cavity

The mouth also called Oral Cavity, or Buccal Cavity, in human anatomy, orifice through which food and air enter the body. The mouth opens to the outside at the lips and empties into the throat at the rear; its boundaries are defined by the lips, cheeks, hard and soft palates, and glottis. It is divided into two sections: the vestibule, the area between the cheeks and the teeth, and the oral cavity proper. The latter section is mostly filled by the tongue, a large muscle firmly anchored to the floor of the mouth by the frenulum linguae. In addition to its primary role in the intake and initial digestion of food, the mouth and its structures are essential in humans to the formation of speech.

The chief structures of the mouth are the teeth, which tear and grind ingested food into small pieces that are suitable for digestion; the tongue, which positions and mixes food and also carries sensory receptors for taste; and the palate, which separates the mouth from the nasal cavity, allowing separate passages for air and for food. All these structures, along with the lips, are involved in the formation of speech sounds by modifying the passage of air through the mouth.3How the mouth is normally lubricated and kept moist ?

The oral cavity and vestibule are entirely lined by mucous membranes containing numerous small glands that, along with the three pairs of salivary glands, bathe the mouth in fluid, keeping it moist and clear of food and other debris. Specialized membranes form both the gums (gingivae), which surround and support the teeth, and the surface of the tongue, on which the membrane is rougher in texture, containing many small papillae that hold the taste buds. The mouths moist environment and the enzymes within its secretions help to soften food, facilitating swallowing and beginning the process of digestion4Which mouth lacks mucous membranes?

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Factors that may influence poor oral health and hygieneIllness Risk Factors Diabetes Limited/restricted fluidsThyroid dysfunction Mouth breathersOral disease/trauma ConfusionCerebrovascular disease DepressionDebility Terminal illnessAcute/chronic breathing disordersPoor nutritional statusOxygen therapy Lack of motivationInsufficient saliva Inability to perform activity Intensive care patients Immunosuppressive, transplant pts Risks Continued...

Drugs Impact Cytotoxic/Chemotherapeutic drugs Reduces the auto-immune response CorticosteroidsAffect the healing properties of tissuesAntibiotics Alter the bacterial balance of commensal organisms in the mouth and allow candidal invasionsAntispasmodicsAlter gut mobility and reduce salivary productionAntihistamines, Anticholinergics, Psychotropic's, Antidepressants These groups of drugs reduce salivary production Diuretics Potential dry mouth due to increased fluid loss Morphine Strong association with dryness of the mouth 7Risks Cont...TreatmentsRadiotherapy to head and neck Reduces ability to eat/drink normallyLocalised inflamation Oxygen therapy Un-humidified oxygen administered by mask can dry mouth Intermittent suctionPotential risk of damage to oral tissues Restricted oral intake Potential dehydration Anaesthesia Reduces oral secretion Potential problems Stomatitis Inflammation and infection of the oral mucosaOral Thrush Caused by a yeast like fungus.Ulceration UlcersDental caries Decay and cumbering of tooth choice of equipment for patient useGloves, Apron Clinical waist bag/bin Tongue depressor Torch for mouth examinationToothbrush/denture potMouth wash Fluoride toothpaste / denture cleaner Foam sponge sticksPlastic beakerJug of waterReceiver Box of tissuesTowel Give Nursing Times Mouth Care Sheet 9choice of solution for patient useOral care products When recommended Sodium bicarbonate dilute one teaspoon in 500ml of warm waterUse onceWhen tenacious mucous is present or mouth is crusted Glycerine/ thymol tablets 1 tablet to a beaker of waterUseful for refreshing mouth, plays no part in cleaning. Effect 20 minsCorsodyl rinse the mouth with 10mls for about one minute twice a day Highly recommend, inhibits bacterial growth Nystatin 100,000 units four times a day after food, usually for seven days If patient wears false teeth, remove before introducing Oral fungal infectionsToothpaste, use a small amount on toothbrush Highly recommended Tap water, refreshing-ideal ph of sevenRecommended to moisten mouthPineapple cubes/juice tinned ok but better if fresh Ideal for dry mouths, contains a photolytic enzyme that cleans the mouthEmollient (Vaseline) apply to lipsPrevent cracked lipsLip Balm (apply to lips only Prevent lips cracking, easy to apply What may influence oral hygieneAppropriate communicationConsidering the persons ability Hospital guidelines on mouth careProviding equipment and assistance (if needed)Encouraging the patient to participate Considering the environment Ensuring an appropriate position Documenting findings 11Remember If you think a patient needs an oral assessment notify a registered nurse to ensure the proper treatment can be issued"

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