Oral care is a vital procedure for critically ill patients in the intensive care unit (ICU). Oral care may affect the clinical result as well as the wellness of intensive care patients

2. Care of
the
mouth
Normally the mouth is
kept clean in health.
Because the mouth is
the portal of entry for
food and digestion is
started here. So the
condition of the mouth
directly affects health.
Oral hygiene is the
practice of keeping
your mouth clean
and disease-free.

3. Purposes
 To feel fresh and clean and
socially accepted.
 To prevent and treat mouth
infections.
 To stimulate salivation.
 To prevent infection of parotid
glands
 To help to increase appetite.
 To prevent dental carries and
tooth decay.

4. The patients
who may
require
mouth
care
 Unconscious patients and
helpless patients.
 Patients with high fever.
 Patients on fluid diet or milk diet.
 Paralysed patients.

5. The patients
who may
require
mouth
care
 Seriously ill patients.
 Patients having a local disease of
the mouth.
 Patients who are on artificial
feeding and who are not taking
oral feed.
 Malnourished and dehydrated
patients.

6. Solutions
used
 Potassium permanganate - [KMNO4] -
1: 5000. a pink colour. It should be made
fresh each time. Used as a oxidizing agent
to clean the mouth.
 Hydrogen peroxoide - [H2O2] 5 cc to 20
cc as a deodorizing agent.

7. Solutions
used
 Normal saline - 1 teaspoon to a pint of
water. It is used for cleansing purpose.
 Soda-bi-carb - 1 Tsf to a pint of water. It
dissolves the coating of mucus membrane
and cleanse the mouth.
 Glycerine Borax - It is hygroscopic and
used to soothe or soften the mucus
membrane. Useful when the lips are dry
and cracked.

8.  Parotitis - Inflammation of the parotid
glands.
 Stomatitis - Inflammation of the mucus
membrane of the mouth.
 Gingivitis - Inflammation of the gums.
 Glossits - Inflammation of the tongue.
 Otitis media - Inflammation of the
middle ear.

10.  Pyorrhoea - Pus formation in the sockets
of teeth.
 Tonsilitis - Inflammation of the tonsils.
 Gastritis - Inflammation of the stomach.
 Anorexia - Loss of appetite.

11. Articles
 A Clean tray containing -
1. Artery forceps - 1.
2. Dissecting forceps - 1.
3. Face towel - 1.
4. Treatment mackintosh.
5. Cotton swabs in a bowl.
6. Tongue depressor.
Tongue depressor.

12. Articles
 A clean tray containing -
7. A bowl with clean water.
8. Kidney tray and paper bag.
9. Gauze pieces.
10. Feeding cup. Solution ordered.
11. Glycerine borax.
12. Swab sticks to apply the
glycerine borax.
13. Mouth gag. (If patient is
unconscious to open the mouth.)
Mouth gag.

13. 1. Explain the procedure to the patient [
if the patient is conscious] to gain the
confidence and co-operation of the
patient.
2. Give comfortable position to the
patient.
Procedure

14. 3. Screen the patient. Arrange the
articles conveniently.
4. Wash hands to prevent cross
infection.
5. Place the mackintosh and towel
beneath the patients chin. Place the
kidney tray close to the cheek.
6. Prepare the antiseptic lotion for
the mouth wash, prepare a paste with
soda bicarbonate or salt.

15. 7. Do not pour water into the mouth, if the patient is
unconscious, because due to poor gag reflex the fluid will go
into the trachea wrap a swab around the forceps covering the
tips completely and clean the mouth systematically changing
the swabs as often as necessary. If the patient is wearing
dentures, remove these first and place them in a bowl of
water, clean the mouth in the following order
- Inside the cheeks.
- Gums.
- Teeth.
- Roof of the mouth.
- Lips.

16. 8. Wipe the tongue gently from side to side. If
necessary use tongue depressor to control the
movements of the tongue, by depressing it.
9. For a conscious patient - tooth brush and paste can
be used.
10. As each swab becomes soiled, remove it with the
dissecting forceps, and wrap clean swab round the
artery forceps.

17. 11. Repeat the whole process with swabs dipped in the solution
and then fresh water.
12. When the teeth and tongue cleaned well, stop the procedure,
wipe the lips and face with the towel.
13. Apply glycerine borax on the cracked lips and tongue,
because glycerine attracts water and heep them soft.

18. After care of
patient &
articles
 1. Remove the kidney tray,
treatment mackintosh and towel.
2. Make the patient comfortable.
3. Replace cleaned dentures if
worn.
4. Take all articles to the utility
room, discard the wastes and clean
them with soap and water.
5. Boil the forceps and replace
them in their usual places.
6. Wash hands.

19. Recording
Reporting
 1. Record the procedure with date
and time, and the condition of the
mouth on the nurses record.
2. Report any abnormal condition
to the ward sister and physician.
3. Give health education to the
patient and his relatives on oral
hygiene.

20. Scientific
principles
of mouth
wash
 Anatomy and Physiology -
1. Oral or buccal cavity is formed as
follows - The lips are in front, the cheeks
on the sides, and the back communicates
with the pharynx.
2. The mouth is lined with mucus
membrane.
3. There are six openings opened in the
pharynx. Two openings of the nostrils,
one trachea, one oesophagus and two are
of eustachian tubes.
4. The mouth contains the tongue,
salivary glands, and teeth.

21. Scientific
principles
of mouth
wash
 Tongue- The tongue is made up of skeletal muscles
and is covered with mucous membrane. The papillae
on the tongue contains taste buds. Sweet taste in the
front, bitter at the back and sour and salty taste is at
the side of the tongue.
The function of the tongue is it helps speaking and in
eating.
5. Salivary Glands - There are three sets of salivary
glands, in the mouth. Namely parotid, sublingual and
submaxillary glands. They secrete saliva when the
taste buds are stimulated by the smell, sight, feel and
thought of food.
Saliva contains ptyalin, which hydrolyzes strach.
6. Teeth - Temporary or Deciduous teeth are 20 in
number and permanent teeth are 32 in number.

22. Scientific
principles
of mouth
wash
7. The teeth are covered by a dense fibrous membrane
over which is smooth mucous membrane called
gums.
8. Each tooth has three parts - a root, a neck, and a
crown. The outside of the crown is enamel which is
the hardest substance in the body and it is affected
only by acids.
9. The outside of the root is cement. Under the enamel
of the crown and the cement of the root is dentine.
Dentine contains tubules which brings nourishment.
10. The pulp of the tooth, lies within the dentin.
Pulp contains blood vessels and nerve branches
from the fifth cranial nerve.
11. For normal development of the teeth
mastication of hard fibrous food, firm, raw fruits
and vegetables are required.

23. Scientific
principles
of mouth
wash
 Microbiology -
1. Many bacteria are found in normal healthy
mouth, among which are the pneumococci, the
staphylococci and the streptococus.
2. Saliva is mildly bactericidal.
3. The mouth represents all requirements for
bacterial growth - warmth, moisture, food supply
from the residual foods on and between the teeth
and a protected environment.
4. If oral hygiene is not maintained it will lead to
the diseases of the teeth and mouth.
5. Mouth washes help to remove food particles
after they have brushed from the teeth.

24. Scientific
principles
of mouth
wash
6. Oral cleanliness is preventive against dental carries.
7. Bacillus acidophilus causes dental carries. It acts on
carbohydrate material which is left on the surfaces
and produces lactic acid that dissolves the tooth
structure.
8. The molars, the bicuspids and upper incisors are most
liable to decay.
9. Inflammation of the gums may be caused by poor
oral hygiene, bacterial infection or deficiency of vit.
C in the diet. Gingivitis may lead to pyorrhoea.
10. Sores is a collection of food, mucus and bacteria in
the mouth and on the lips. It may lead to infection in
the mouth or adjacent tissues.
11. Dentures should be cleaned well, especially in and
around the claps.

25. Scientific
principles
of mouth
wash
 Physics and Chemistry -
1. Soap is a constituent of most dentifrices, has a
low surface tension so that it spreads readily over
the teeth and penetrates between them.
2. Friction of raw foods against the teeth and gums
produces stimulation.
3. The force of chewing, pushing the gelatinous
bacterial plaque and lactic acid into the pits and
crevices, may be partially responsible for the speed
of dental decay.
4. A dentures should be dipped in cold water to
avoid friction with the mouth and to make it slide
easily into place.
5. When a nurse attending mouth care the pt should
be near the working side of the bed to prevent strain
for the patient and the nurse.
6. The nurse should stand erect to avoid strain on
back muscles.

26. Scientific
principles
of mouth
wash
 7. The teeth are formed of calcium and
phosphorus. So for healthy growth of the teeth
these minerals are necessary.
8. Vitamin D helps in the assimilation of the
calcium and phosphorus.
9. Vitamin A controls the growth of enamel.
10 Vitamin C is necessary for formation of
dentin.
11. Saliva consists of 99.5 percent water and
0.5 percent total solids. Its constitutnts are
water, inorganic salts, mucin, traces of protein
and salivary amylase or ptyalin.

27. Scientific
principles
of mouth
wash
12. Saliva is slightly acid in reaction and its pH is
between 6.35 to 6.85. Sweets increase the acid
reaction of the saliva.
13. Tartar consists of mineral matter precipitated
from saliva mixed with food debris. The pressure
of tartar against the gums irritates them and
lowers their resistances to bacteria.
14. The flourine limits the bacterial activity and
reduces the acid reaction of the saliva.
15. Synthetic vit. K retards the formation of acid in
the mouth.
16. Dentifrices clean the mouth by mechanical
action rather than chemical action on bacteria.

28. Scientific
principles
of mouth
wash
 Pharmacology -
1. Glycerine with lemon juice helps in
softening dry lips.
2. All liquid dentifrices contain antiseptics
such as boric acid, phenol, thymol etc.
and flavoured with pappermint, cinnamon
floves etc.
3. Salt solution is a good mouth wash.

29. Scientific
principles
of mouth
wash
 Psychology -
1. A clean mouth makes a person feel
fresh, clean and comfortable.
2. Daily brushing of teeth is a desirable
esthetic habit.
3. A set of sound teeth is valuable asset as
it contributes to personal apperance.
4. Privacy should be provided to the
patient while caring for his dentures.