This document provides information on oral hygiene and care of the mouth. It discusses personal hygiene, oral care, dental development, assessment of oral health, common oral problems like dental caries and periodontal disease, plaque, tartar, gingivitis, and measures to prevent tooth decay. Good oral hygiene includes daily brushing, flossing, and flushing of the mouth. The nurse's role involves assessing the client's oral hygiene needs and providing assistance with brushing, flossing, and mouth care for those who are unable to do it themselves, in order to maintain oral health.

1. HYGIENE

2. HYGIENE
• Hygiene is the science of health and its
maintenance.
• PERSONAL Hygiene is the self-care by which
people attend to such functions as:
•Bathing
•Toileting
•General body hygiene
•Grooming
• Hygiene is a highly personal matter determined
by individual values and practices.
• It involves care of the skin, hair, nails, teeth,
oral and nasal cavities, eyes, ears and
perineal-genital areas.

3. ORAL CARE
Oral hygiene is the
practice of keeping the
mouth is the practice
of keeping the mouth
and teeth is the
practice of keeping the
mouth and teeth clean

4. DEVELOPMENTAL VARIATIONS
– Teeth usually appear 5 to 8 months after birth.
– Baby-bottle syndrome may result in decay of all of the
upper teeth and the lower posterior teeth.
– This syndrome occurs when an infant is put to bed with
a bottle of sugar water, formula, milk, or fruit juice.
– The carbohydrates in the solutions cause
dimineralization of the tooth enamel which leads to
tooth decay.
– By the time children are 2 years old, they usually have
all 20 of their temporary teeth.
– At about age 6 or 7, children start losing their
deciduous teeth, and these are gradually replaced by
the 33 permanent teeth.
– By age 25, most people have all of their permanent
teeth.

5. ASSESSMENT
NURSING HISTORY - The nurse obtains data
about the client’s:
•Oral hygiene practices including dental visits – helps
the nurse determine learning needs and incorporate
the client’s needs and preferences in the plan of care.
•Self-care abilities – determines the amount and type of
nursing assistance to provide
– Client’s who need assistance from the nurse:
❖ Whose hand coordination is impaired – stroke patient
❖ Whose illness alters energy levels and motivation
❖ Whose therapy imposes restrictions on activities
•Past or current mouth problems – alerts the nurse to
specific interventions required or referrals that may be
necessary.

6. ORAL PROBLEMS
•DENTAL CARIES
or cavities are
holes or
structural
damage in the
teeth.

7. DENTAL CARIES
• DENTAL CARIES (cavities) and periodontal
disease are the two problems that most
frequently affect the teeth. Both problems are
commonly associated with plaque and tartar
deposits.
– Cavities are holes, or structural damage, in the teeth.
– Tooth decay is one of the most common of all
disorders, second only to the common cold.
– It usually occurs in children and young adults but can
affect any person. It is a common cause of tooth loss
in younger people.

8. ORAL PROBLEMS
•PLAQUE is an
invisible soft
film that
adheres to the
enamel surface
of teeth.

9. PLAQUE
• Bacteria are normally present in the mouth. The bacteria
convert all foods -- especially sugar and starch -- into
acids.
• Bacteria, acid, food debris, and saliva combine in the
mouth to form a sticky substance called plaque that
adheres to the teeth.
• It is most prominent on the back molars, just above the
gum line on all teeth, and at the edges of fillings.
• Plaque begins to build up on teeth within 20 minutes
after eating (the time when most bacterial activity
occurs). If this plaque is not removed thoroughly and
routinely, tooth decay will not only begin, but flourish.
• When plaque is unchecked, tartar (dental calculus) is
formed.
• The acids in plaque dissolve the enamel surface of the
tooth and create holes in the tooth (cavities).

10. ORAL PROBLEMS
•TARTAR is a
visible hard
deposit of plaque
and dead
bacteria that
forms at the gum

11. ORAL PROBLEMS
• Tartar build up can
alter the fibers that
attach the teeth to the
gum and eventually
disrupt bone tissue.
Periodontal disease is characterized by:
•Gingivitis (Red swollen gingival)
•Bleeding
•Receding gum lines
•And the formation of pockets between the teeth and
gums.

12. ORAL PROBLEMS
•GINGIVITIS is
inflammation of
the gums.

13. ORAL PROBLEMS
•GLOSSITIS is
inflammation
of the tongue
•STOMATITIS is
inflammation of
the oral mucosa

14. ORAL PROBLEMS
• PYORRHEA is an
advanced
periodontal disease
where the gums
appear spongy and
bleeding.
• the teeth are loose and
pus is evident when the
gums are pressed.

15. ORAL PROBLEMS
• CHEILOSIS or
cracking of lips
•HALITOSIS or bad breath
•Excessive dryness of the buccal mucosa
•SORDES or accumulation of foul matter on the
teeth and on the lips

16. MEASURES TO PREVENT TOOTH DECAY
• Brush the teeth thoroughly after meals and at bedtime.
Assist children or inspect their mouths to be sure the
teeth are clean. If the teeth cannot be brushed after
meals, vigorous rinsing of the mouth with water is
recommended.
• Floss the teeth daily.
• Ensure an adequate intake of nutrients, particularly
calcium, phosphorous, vitamin A, C, D and fluoride.
• Avoid sweet foods and drinks between meals. Take them
in moderation at meals.
• Eat coarse, fibrous foods (cleansing food) such as fresh
fruits and raw vegetables.
• Have topical fluoride applications as prescribed by the
dentist.
• Have a check up by a dentist every 6 months

17. GOOD ORAL HYGIENE
• Daily stimulation of
the gums.
• Mechanical brushing
and flossing of the
teeth
• Flushing of the mouth

18. BRUSHING & FLOSSING TEETH
• Thorough brushing of the teeth is
important in preventing tooth
decay.
• The mechanical action of brushing
removes food particles that can
harbour and incubate bacteria.
• It also stimulates circulation in the
gums, thus maintaining their
healthy firmness.

19. PURPOSES
• To remove food particles from
around and between teeth.
• To remove dental plaque.
• To promote the client’s feelings of
well being.
• To prevent sores and infection of
the oral tissues.

20. PREPARATION
ASSESS:
• Determine the extent of the client’s self-care
abilities.
• Assess the client’s usual mouth care practices
• Inspect lips, gums, oral mucosa, and tongue for
deviations from normal.
• Identify presence of oral problems such as tooth
caries, halitosis, gingivitis, and loose or broken
teeth.
• Check if the client has bridgework or wears
dentures.

21. ASSESSMENT SKILLS
1. Introduce
yourself and verify
the client’s identity.
Explain to the client
what you are going
to do, why it is
necessary, and how
the client can
cooperate.

22. 2. ASSEMBLE EQUIPMENTS
Towel Disposable gloves Emesis basin Toothbrush
Cup of tepid water Toothpaste Mouthwash Dental floss

23. 3.Provide for
client privacy
by drawing the
curtains or
closing the door.

24. 4. Wash hands
and put on gloves

25. ASSESSEMENT SKILLS
• CONSCIOUS
PATIENT
• 5. Prepare the
client.
Assist the client in a
high Fowler’s position

26. 6. Place the towel under the client’s chin and lower
cheek to receive thr fluid from the mouth.
7. on disposable gloves.
Apply the toothpaste to the toothbrush
8. Brushes the teeth carefully and avoid injuring
the gums.
9. Rinses thoroughly.
10. Make sure that all the rinsing solution has run
out from the mouth to the basin.
11. Clean mouth tissues with foam swabs or gauze
and cleaning solution on one cheek if they
appear dry and unclean.

27. 12. Does the same on the other area
13. Discard the swab, tongue blades in the waste
container.
14. Rinse the client’s mouth
15. Remove the basin, and dry around the client’s
mouth with the towel
16. Returns artificial dentures
17. Lubricate the client’s lips with lip moisturizer
18. Removes and discard gloves
19. Documents care.

28. Brush the teeth.
Hold the brush against the teeth with the bristles at
a 45 degree angle. The tips of the outer bristles
should rest against and penetrate under the gingival
sulcus/folds (SULCULAR TECHNIQUE).

29. Brush the teeth.
Repeat until all
outer and inner
surfaces of the
teeth and sulci of
the gums are
cleaned.

30. Brush the teeth.
Clean the biting
surface by
moving the brush
back and forth
over them in
short strokes.

31. Brush the teeth.
Brush the
tongue gently
with the
toothbrush.

32. Brush the teeth.
• Hand the client the water cup or
mouthwash to rinse the mouth vigorously.
Then ask the client to spit the water and
excess dentrifice into the basin.
• Repeat the preceding steps until the
mouth is free of dentrifice and food
particles.
• Remove the curved basin and help the
client wipe the mouth.

33. Floss the teeth.
• Wrap one end
of the floss
around the third
finger of each
hand.

34. Floss the teeth.
• To floss the upper
teeth, use your
thumb and index
fingers to stretch
the floss.
• Move the floss up
and down
between the
teeth.

35. Floss the teeth.
• When the floss
reaches the gum line,
gently slide the floss
into the space
between the gum and
the tooth.
• Gently move the floss
away from the gum
with up-and-down
motions.

36. Floss the teeth.
• To floss the lower teeth,
use your index fingers to
stretch the floss, and
follow preceding
instructions.
• Give the client tepid
water or mouthwash to
rinse the mouth and a
curved basin in which to
spit the water.
• Assist the client in wiping
the mouth.

37. Floss the teeth.
• Remove and dispose of equipment
appropriately.
– Remove and clean the curved basin.
– Remove and discard the gloves.
• Document assessment of the teeth,
tongue, gums and oral mucosa.

38. UNCONSCIOUS PATIENT
• Mouth care for
unconscious or
debilitated people
is important
because their
mouths tend to
become dry and
consequently
predisposed to
tooth decay and
infections.

39. CLIENTS WITH SPECIAL ORAL HYGIENE NEEDS
• For the client who is debilitated or unconscious or who
has excessive dryness, sores, or irritations of the mouth,
it may be necessary to clean the oral mucosa and tongue
in addition to the teeth.
• Depending on the health of the client’s mouth, special
care may be needed every 2 to 8 hours.
• Mouth care for unconscious or debilitated people is
important because their mouths tend to become dry and
consequently predisposed to tooth decay and infections.
• Saliva has antiviral, antibacterial and antifungal effects.
• Dry mouth – called XEROSTOMIA – occurs when the
supply of saliva is reduced, which can be caused by:
– Side effects of certain medications (antihistamines,
antidepressants, antihypertensives)
– Oxygen therapy
– Tachypnea
– NPO status

40. PURPOSES
• To maintain the intactness and health of
the lips, tongue, and mucous membranes
of the mouth
• To prevent oral infections
• To clean and moisten the membranes of
the mouth and lips

41. ASSESSMENT
• Inspect the lips, gums, oral mucosa and
tongue for deviations from normal.
• Identify the presence of oral problems
such as tooth caries, halitosis, gingivitis,
and loose or broken teeth.
• Assess for gag reflex if appropriate.

42. EQUIPMENT
• Towel
• Curved basin
• Disposable clean gloves
• Toothbrush
• Cup of Tepid water
• Tissue or piece of gauze (optional
• Mouthwash
• Rubber tipped bulb syringe
• Suction catheter with suction apparatus
• Foam swabs and cleaning solution
• Water-soluble lip moisturizer

43. ASSESSMENT SKILLS
1. Introduce yourself and explain the
procedure to the watcher.
2. Assemble the equipment
3. Provide for client privacy by drawing the
curtains or closing the door.
4. Perform hand hygiene & Puts on gloves

44. 5. Position the unconscious client in a side-lying
position, with the head of bed lowered. If the
client’s head cannot be lowered, turn it to one
side.
6. Place the towel under the client’s chin.
7. Place the curved basin against the client’s chin
and lower cheek to receive the fluid from the
mouth.
8. Brushes the teeth carefully and avoid
injuring the gums.

45. 9. Rinse the client’s
mouth by
drawing about
10ml of water or
alcohol-free
mouthwash into
the syringe and
injecting it gently
into each side of
the mouth.

46. 10. Make sure that all the rinsing solution
has run out of the mouth into the basin. If
not, suction the fluid from the mouth.
11. Repeat rinsing until the mouth is free of
dentrifice used.

47. PROCEDURE
12. Cleans mouth
tissue with foam
swabs or gauze
and cleaning
solution on one
cheek if they
appear dry and
unclean.

48. 13. Does the same on the
other area.
14. Discard the swab /
tongue blades in the
waste container.
15. Rinses the client’s
mouth
16. Removes the basin and
dry around the client’s
mouth with the towel.
17. Replaces artificial
dentures if indicated
18. Lubricates the client’s
lip with moisturizer
19. Remove and discard
gloves

49. PROCEDURE
• Observe the tissues closely for
inflammation and dryness.
• Rinse the client’s mouth as described
above.
• Remove and discard gloves.

50. PROCEDURE
Ensure client comfort.
• Remove the basin, and dry around the client’s
mouth with the towel.
• Replace artificial dentures, if indicated. Lubricate
the client’s lips with water-soluble moisturizer.
• Document assessment of the teeth, tongue,
gums, and the oral mucosa. Include any
problems such as sores or inflammation and
swelling of the gums.

51. ARTIFICIAL DENTURES
Some people
have artificial
teeth in the
form of a plate
– a complete set
of teeth for one
jaw.

52. ARTIFICIAL DENTURES
Some have partial dentures only. When only a few
artificial teeth are needed, the individual may
have a bridge rather than a plate.

53. EQUIPMENT
• Disposable gloves
• Tissue or piece of gauze
• Denture container
• Clean washcloth
• Toothbrush or stiff-bristled brush
• Dentrifice or denture cleaner
• Tepid water
• Container of mouthwash
• Curved basin (emesis basin)
• Towel

54. PROCEDURE
Remove the dentures.
• Put on gloves.
• If the client cannot remove the dentures, take the tissue
or gauze, grasp the upper plate at the front teeth with
your thumb and index fingers, and move the denture up
and down slightly.
• Lower the upper plate, move it out of the mouth, and
place it in the denture container.
• Lift the lower plate, turning it so that the left side, for
example, is slightly lower than the right, to remove the
plate from the mouth without stretching the lips. Place
the lower plate in the denture container.
• Remove a partial denture by exerting equal pressure on
the border of each side of the denture, not on the
clasps, which can bend or break.

55. PROCEDURE
Clean the
dentures.
Take the denture
container to a
sink. Take care
not to drop the
dentures. Place a
washcloth in the
bowl of the sink.

56. PROCEDURE
• Using a toothbrush or special stiff-bristled
brush, scrub the dentures with the cleaning
agent and tepid water.
• Rinse the dentures with tepid running water.

57. PROCEDURE
• If the dentures are
stained, soak them in
a commercial cleaner.
Be sure to follow the
manufacturer’s
instructions. To
prevent corrosion,
dentures with metal
parts should not be
soaked overnight.

58. PROCEDURE
Inspect the dentures and the mouth.
• Observe the dentures for any rough, sharp, or
worn areas that could irritate the tongue or
mucous membranes of the mouth, lips, and
gums.
• Inspect the mouth for any redness, irritated
areas, or indications of infection.
• Assess the fit of the dentures.

59. PROCEDURE
Return the dentures to the mouth.
• Offer some mouthwash and a curved
basin to rinse the mouth. If the client
cannot insert the dentures independently,
insert the plates one at a time. Hold each
plate at a slight angle while inserting it, to
avoid injuring the lips.

60. PROCEDURE
Assist the client as
needed.
• Wipe the client’s hands
and mouth with a
towel.
• If the client does not
want to or cannot wear
the dentures, store
them in a denture
container with water.
Label the container
with the client’s name
and identification
number.

61. AFTER CARE
• Remove and discard the gloves.
• Document all assessments and include
any problems such as an irritated area on
the mucous membrane.

62. Thank you…