Providing Oral Care for the Elderly Client
PROVIDING ORAL HYGIENE
Outlined below are procedures for common oral hygiene tasks. These include brushing and flossing the teeth, cleaning dentures, and mouth care for the unconscious person. The procedures are meant to be guidelines only. If you work for a healthcare agency, your workplace may have policies and procedures for you to follow. Remember too that every person is unique. Follow the person’s care plan. Check for special instructions such as the need for pain relief medication before receiving mouth care. If you are unsure about something, ask the health care professional.
The first step in providing oral hygiene is to prepare the equipment you will need. Being organized enables you to provide care more efficiently and with fewer interruptions. Lay out any items you will need on paper towels on a work area within reach. Remember to ensure the person’s privacy before beginning the procedure.
Inspecting someone’s mouth and providing oral care brings you in contact with saliva, mucous membranes, and possibly blood. You can protect yourself and the person in your care against infection by using standard precautions. Standard precautions are guidelines that treat blood and other body fluids as if they were contagious, regardless of the source. Always wear gloves when giving oral hygiene.
Never use your fingers to keep the person’s mouth open when giving mouth care. Doing so will put you at risk of receiving a bite.
Carry out the procedure as outlined below. When you are finished, place the call bell within reach. Lower the bed to the lowest position (to decrease the risk of injury in the case of a fall) unless agency policy or the person’s care plan directs otherwise.
Brushing the teeth
Some people will be able to gather their supplies and brush their teeth independently. Others may need your help just to set up the equipment. Still others will not be able to assist with the procedure at all. Changes can be made to standard toothbrushes to promote independence by improving the handgrip. An Occupational Therapist should be able to assist in this regard.
-Soft bristled toothbrush (or specialty toothbrush if recommended)
-Toothpaste or other oral cleaning agent
-Small bowl such as an emesis basin
-Straw if necessary
-Towel and facecloth
-Water-soluble lip lubricant
Procedure (Note: We’ll assume here that you are caring for a female patient.)
1. Explain the procedure before you start.
2. Assist the person to a sitting position, next to a sink if possible. If providing care in bed, use the emesis basin. If the person cannot sit up, position the bed at a safe working level, and assist her to a side-lying position. Ensure her head is on a pillow.
3. Use a towel to keep her clothing dry.
4. Wash your hands.
5. Apply disposable gloves.
6. If her lips are dry, apply a lubricant in a thin layer to prevent drying and cracking. The lubricant should be a water-soluble one.
7. Wet the toothbrush with tepid water and apply toothpaste. The toothpaste should contain fluoride as fluoride helps prevent cavities. If she is someone who’s at risk for mouth problems her dentist may order another type of cleaning agent.
8. If she is is able to brush her teeth independently, offer her the toothbrush and assist as required.
9. If she is not able to assist, begin to brush her teeth. Position the toothbrush at a 45-degree angle to her gum line.
10. Gently move the brush back and forth using short strokes.
11. Be sure to brush all the surfaces of the teeth. That would include the inner, outer, and chewing surfaces.
12. Gently brush the tongue if coated to remove bacteria and freshen the breath.
13. Offer her a drink of water to rinse the mouth. Use a straw if required. Hold the emesis basin if necessary so she can spit out the water.
14. If her lips are dry, apply a water-soluble lip lubricant again.
15. Offer mouthwash. Mouthwashes that contain alcohol can have a drying effect on oral tissue and irritate the mouth of someone with stomatitis. For these reasons, many healthcare agencies now use non-alcohol based mouthwashes.
16. Ensure she is as comfortable as possible.
17. Raise the siderails as per her care plan.
18. Clean the equipment and put away the supplies.
19. Remove your gloves and wash your hands.
20. Document the procedure in the appropriate place.
Flossing is usually done after brushing the teeth and at least once a day. Flossing removes food particles and plaque from between the teeth. Assist the people in your care to floss independently if they can. You will need to floss for people who require help.
Floss (or flossing device)
Procedure (Note: We’ll assume here you’re caring for a male patient.)
1. Wash your hands and apply disposable gloves.
2. Break off about 18 inches of floss. Waxed floss results in less fraying than unwaxed floss. Food particles, however, attach more easily to unwaxed floss.
3. Wind one end of the floss around the middle finger of each hand.
4. Hold the floss between your thumb and forefingers.
5. Move the floss between the teeth with a gentle rubbing motion.
6. Using up and down movements, gently rub the floss against the side of the teeth.
7. Repeat the procedure for all the teeth.
8. Don’t forget to keep moving to a clean section of floss as you progress.
9. Once you are finished, offer him a glass of water to rinse the mouth.
10. Ensure he is as comfortable as possible.
11. Raise the siderails as per his care plan.
12. Clean the equipment and put away all of the items.
13. Remove your gloves and wash your hands.
14. Document the procedure in the appropriate place.
A number of flossing aids are available for use by patients or caregivers. These devices include floss wands, floss piks, special brushes, and sticks. Many older people have never gotten into the habit of flossing. They may refuse to floss their teeth or to have you do it for them. You must respect their wishes. Let your supervisor or healthcare professional know that they would prefer not to have their teeth flossed.
If you are caring for an elderly person, it is quite likely that he or she will have dentures (artificial teeth). Dentures may consist of an upper or lower plate or both. Keep in mind that dentures are very expensive items. Many people do not have extra money to replace missing or damaged dentures. Do all you can to ensure the dentures are properly cared for.
Encourage the people in your care to wear their dentures. People who do not wear their dentures are at risk of shrinkage of the gums and further tooth loss. Like natural teeth, artificial dentures need to be cleaned regularly. They should be cleaned at least once a day. Use only recommended cleaning agents. Otherwise you may damage the dentures.
Handle dentures with extreme care. They can easily slip out of your hands and break. They can crack or chip even if they fall in the sink. Ensure that you use gauze or a tissue to remove them from the person’s mouth. The gauze or tissue will improve your grip on the dentures. Place a washcloth (or small towel) in the sink when you are cleaning dentures. Never use hot water for cleaning as it can change the shape of the dentures.
Dentures should be removed at night. This helps to give the gums a rest and prevent a buildup of bacteria. When not in use, dentures should be placed in cool water in a denture cup. Clearly label the cup so that your patient’s dentures are not mistaken for someone else’s. As well, most facilities have denture-marking kits on hand for labeling of dentures. Labeling is the best way to ensure that someone’s dentures do not wind up in someone else’s mouth.
Some people will be independent in caring for their dentures, while others will need some assistance from you. Still others will not be able to assist with the procedure at all. To promote independence, encourage people to help with denture care to the extent that they are able.
Small bowl such as an emesis basin
Soft-bristled toothbrush or denture brush
Toothpaste or other recommended cleaning agent
Washcloth (or small towel)
Tissue or gauze
Cup of cool water
Procedure (Note: We will assume here that the person in your care is a woman.)
1. Explain the procedure before you begin.
2. Assist her to a sitting position.
3. Use a towel to keep her clothing dry.
4. Wash your hands.
5. Put on disposable gloves.
6. Ask her to remove her dentures and place them in the basin. If she is unable to do so, remove the dentures. Using a tissue or gauze, grasp the top dentures at the front teeth with your thumb and forefinger. Move the denture up and down gently to break the suction. Remove the bottom denture by lifting upwards while turning slightly to one side. Place the dentures in the denture cup. Carefully take them to the sink.
7. Place a washcloth (or small towel) in the sink to help prevent the dentures from breaking if you drop them.
8. Under tepid running water, rinse the dentures. Instructions on some cleaning agents are to use cool or warm water.
9. Holding the dentures in the palm of your hand, use the brush and scrub them with toothpaste or other cleaning agent. Rinse well.
10. If the dentures are stained, they can be soaked in a commercial denture cleaner. Follow the directions on the package if you do so. Dentures with metal parts should not be soaked overnight to prevent wearing away of the metal.
11. Offer her a glass of water or mouthwash so she can rinse her mouth.
12. Ensure the dentures are well rinsed before they are placed back into her mouth.
13. Ensure she is as comfortable as possible.
14. Raise the siderails as per her care plan.
15. Clean the equipment and put away the supplies.
16. Remove your gloves and wash your hands.
17. Document the procedure in the appropriate place.