Oral Hygiene in the hospital setting is much more important than you might think. Think of one day, of those corridos, that a professional correctly sanitizes the patient, but forgets the most important: The oral cleaning. Yes! Unfortunately it is still a reasonable number of situations in which several professionals fail to perform this simple act when giving that bath or intimate hygiene in the patient.
Did you know that the lack of oral hygiene of bedridden patients creates an environment conducive to the proliferation of bacteria in the oral cavity? The bacterial plaque ends up acting as a reservoir for the colonization of respiratory bacteria. In cases of incidence in Intensive Care Units, for example in a certain Institution, there were 33.3% of incidences due to Mechanical Ventilation-Associated Pneumonia. After the implementation of the Prevention Bundle by the CCIH, there was a sudden drop in infections, to 3.5%.
But it’s not just pneumonia that prevails! There are several changes, such as: Lip changes such as Simple Herpes, contact dermatitis, actinic cheilitis, in cases of mouth changes such as leukoplakia, lichen planus, candidiasis, aphthous stomatitis, and Kaposi’s sarcoma ; and in cases of gum changes, we have gingivitis and periodontitis.
Patients with certain heart problems or an artificial joint are considered at high risk for the development of a heart infection called infective endocarditis (IE), and receive preventive antibiotics before a dental procedure. Poor oral hygiene leads to chronic and acute infections such as abscesses. The patient is at risk of frequent bacteremia and presumed endocarditis if he has a heart problem or other condition that puts him at risk.
Complications of Oral Hygiene: Alternative Methods
Due to the variation of the level of dependence of the patient, and to the problems in the oral cavity, some special methods are used for the oral hygiene by the nursing technician. In cases of patients admitted to hospital beds, toothpaste and brush can be used, and in cases where the patient can help, it is easier to expel the buccal contents in a kidney tub. When the patient is totally dependent, one can use the aspiration brushing method (there are special brushes), or the method of dolls for oral hygiene, as non-alcoholic antiseptic products, and using chlorhexidine.
In cases of critical patients in ITU beds (most are intubated and unconscious), the method of brushing with aspiration is very used, and the oral antiseptic with chlorhexidine is used. Because they are in situations where intubation makes swallowing difficult, saliva accumulates in the oral cavity, thus increasing the chances of getting a respiratory tract infection.
Saliva contains certain enzymes, such as lactoferrin, lysozyme and the peroxidase system, which strengthen the immune system of the mouth. Microorganisms present on the bacterial plaque can be released into the salivary secretions and then aspirated into the lower respiratory tract (lung). Therefore, the use of mouthwashes with these enzymes will reinforce the oral hygiene of bedridden patients, and perform aspiration whenever necessary.
The first thing that comes to mind when we think of diseases caused by lack of hygiene are caries. They arise from food residues that remain in contact with the teeth, attracting bacteria and causing acid production that can destroy the structures of the teeth.
If not treated quickly, caries can evolve and cause tooth pulp death, abscess formation or even infection. Remember that poor diet (high sugar intake) and some medicines used as antibiotics can make teeth more vulnerable to cavities.
Bad breath is related to poor oral hygiene, dry mouth and the ingestion of certain foods. Usually this problem worsens in the morning, due to the lower production of saliva during the sleep period.
Although there is no specific cause for the onset of canker sores, it is well known that poor oral hygiene can contribute to its appearance and make healing difficult. Injuries to the mucous membrane of the mouth have a white and reddish color around them and often cause pain and discomfort, especially at feeding time.
An oral problem also very common in the population, which can progress to periodontitis if not treated correctly. Gingivitis arises when there is plaque buildup, causing inflammation of the gums, which can result in redness, swelling and bleeding. If the plaque is not removed, it begins a hardening process, forming the tartar, which adheres to the tooth and can progressively destroy the structures that support the teeth.
The inflammation caused by the evolution of untreated gingivitis is called periodontitis, and has symptoms like bleeding, tenderness, bad breath, receding gums and can result in tooth loss.
One of the most serious problems stemming from lack of oral hygiene, bacterial endocarditis is an infection that directly affects the heart, and can lead to death. A simple bleeding in the mouth can allow mouth bacteria to enter the blood system and reach for valves or tissues, causing damage to the lining of the heart.
Nursing Care with Oral Hygiene
Materials to be used:
- Disposable cup with water;
- Face towel;
- Kidney bowl;
- Lubricant for lips;
- Oral antiseptic;
- Procedure glove;
Patient procedure with little limitation:
In Fowler’s position and with the lateralized head;
- Protect the chest with the face towel;
- Put the kidney bowl under the cheek;
- Ask her to open her mouth or open it with the aid of the spatula;
- Use the brush with root movements towards the end of the teeth. Do about 6 to 10 movements on each tooth surface, with constant brush pressure;
- Repeat this movement on the buccal and lingual surface, tractioning the tongue with a spatula protected with gauze;
- Offer glass with water to rinse the mouth;
Procedure in patient with prosthesis:
- Request that you remove the prosthesis or make it through the gauze;
- Put it in the kidney bowl;
- Brush the gingiva, palate and tongue if the patient can not do it;
- Offer it for the patient to put still wet.
Procedure in an intubated or unconscious patient:
- For an unconscious patient, the best position is lateralized with the patient’s head facing the side where you are, semi Fowler or with the head of the bed at normal level. Placing the patient in one of these positions allows fluids or any oral secretions to accumulate on the dependent side of the mouth and flow out;
- Use a soft bristled brush and antiseptic solution to brush your patient’s teeth and remove any buildup of dirt and plaque;
- A doll made of gauze or gauze soaked in antiseptic can also be used to clean the patient’s tongue and gums. Remove possible crusts and dirt;
- Perform aspiration of the contents of the oral cavity with a smaller caliber aspiration probe to prevent injury to the oral mucosa;
- Because the unconscious patient can not report pain or discomfort, perform a thorough assessment of the oral cavity each time you perform oral hygiene;
- Enjoy the oral care to observe the presence of inflammations, infections, ulcerations or bleeding. Communicate to the nurse responsible and the doctor for immediate treatment, since oral health problems can affect the overall health of the patient.