Rehabilitative Services

A Caregiver’s Guide to

Good Oral Care for Patients

This booklet provides information regarding appropriate oral care methods for people with different oral care needs. We hope that this information will be useful in helping you to provide better oral care for your loved one.

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What is oral care? Oral care is the mechanical removal of oral bacteria by brushing the entire oral

cavity. Your loved one may require intensive oral care at least twice a day to ensure his/her mouth is free from bacteria overgrowth. Intensive oral care may reduce the incidence of aspiration pneumonia by:• Reducingcolonizationofbacteriaintheoralcavityandsaliva• Improvingcoughreflexsensitivity• Enhancingsalivaproduction

Why is oral care important? Oral care is important in maintaining good oral hygiene. Good oral hygiene can haveasignificantimpactonaperson’sgeneralwell-beingandthequalityoflife.

Conversely, poor oral hygiene can lead to mouth pain, gum disease and tooth loss. If left untreated, severe gum disease may infect the surrounding bone and tissue, leading to other systemic diseases. Poor oral hygiene also increases risk ofpneumonia,especiallyinpatientswithdysphagia(swallowingdifficulty).Researchshowsthatgoodoralcaremethodscanreducehospitaladmissions.In addition, prolonged poor oral care may also lead to malnutrition, as patients tend to eat less when there is ulcer or pain in the mouth.

Contrary to conventional belief, patients with no remaining dentition also need oral care especially for gum surfaces, palate and tongue area where bacteria can colonize.Itisalsoimportanttonotethatpatientsontube-feedingalsorequireoral care. As these patients are more prone to pneumonia due to the presence ofswallowingdifficulty,oralcareneedstobedonethoroughlyforthem.

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2. Foamswabsorsterilizedcottongauze/softcloth• Forpatientswithbleeding,difficultyinswallowing

and/or tendency to bite on a toothbrush• Formostpatients,usewithnormalsalinemouthwash

ornon-alcoholicmouthwashe.gColgatePlax• Forpatientswhojustunderwenttoothextraction

or have mouth ulcers• Chlorhexidine0.2%mouthwashmaybeusedfor

up to 4 weeks • Singleuseonly

Oral Cleaning Agents 1. Fluoride toothpaste

Preparing for Oral CareOral Cleaning Tools1. Toothbrushes

• Thebestoptionfororalcleaning• Cleansbetterthanswabs• Economical• Usesmall-endedtoothbrusheswith

soft bristles

2. NormalsalinemouthwashOR Non-alcoholicmouthwash e.g.ColgatePlax(Avoidglycerine- oralcohol-basedagents)3. Chlohexidine0.2%mouthwashONLY

when needed

Additional Materials1. Lipmoisturizer2. Denture cleaning agent (Notcompulsory.NOTSUITABLEfor

METALDENTURES)

Toothbrush

FoamSwab

CottonGauze

Saltwater

Mouthwash

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Cleaning the Oral CavityPhysically Independent PatientsForpatientswhoarephysicallyindependent,havenosignificantswallowingdifficultyand are able to gargle.• Performoralcareatleasttwiceaday.• Useatoothbrushwithflouridetoothpastetobrushallteeth,gums,tongue,

palate areas for at least 2 minutes.• Garglewithsodiumchloridesolutionorwatertwiceadayoraftereverymeal.• Usesoft-bristle,soft-endedtoothbrush.

Usetoothpastetobrushthroughalltooth,gum and tongue surfaces

PatientsRequiringAssistanceinOralCare1. Assisted patients: Conscious patients requiring some assistance in oral hygiene, having someswallowingdifficultyand/orareunabletogargle2. Dependent patients: Unconscious patients requiring complete assistance, having significantswallowingdifficultyand/ortareunabletogargle

• Performoralcareatleasttwiceaday(afterwakingupandbeforegoingtosleep).Increasefrequencyifpatienthassignificantdroolingandsecretions.For person who has food residue kept in the mouth, oral care should also be performed after meals.

• Washanddryhandsthoroughly,andputonglovesbeforeperformingoral hygiene.

• Ifpatientstillhassomeremainingteeth,brushall toothsurfaceswithatoothbrush, followedbyfoamswaborsterilegauzedipped insodiumchloride solution.

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1) Usesodiumchloridesolutionorchlorhexidine0.2%mouthwash

2) Squeezethefoamswabdrybeforeuse

• Forpatientwithnoremainingdentition,useafoamswaborsterilecottongauzedippedinsodiumchloridesolutionORnon-alcoholicmouthwashtocleanallsurfacesoforalcavity(includingpalate,gums,innercheekareas)foratleast2minutes.

• Forpatientwithverypoororalhygiene,usechlorhexidine0.2%mouthwash(notmorethan4weeks)inplaceofsodiumchloridesolution.

• Applylipmoisturiserormoistenlipswithdampcottongauzeifneeded.Forpatient with thick, crusted secretions, moisten mouth regularly. DO NOT peel offdrysecretion.

• Dependentpatientsmayalsorequiresuctioning.

3) Cleanallareasofthemouth,includinggums,tongueandpalate

Cleaning Dentures• Cleanwithadenturebrushorsofttoothbrushandwateratleasttwiceaday.• Soakdenturesincleanwaterwhennotinuse.• Onceaweek,soakindenture-cleansingagentstoremovestains.Rinseoffcleaning

agent before wearing dentures.• Keepdenturesinacleandenturestoragecontainer,completelysoakedinwater.

SodiumChlorideSolution

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Clean all surfaces of the dentures, including the teeth and underside

Soakdenturesinwaterwhennotinuse

OtherUsefulTips• UsenormalsalineifpatientishypersensitivetoChlorhexidineorisonNystatintreatment.• Avoidfoodanddrinksfor30minutesafterusingchlorhexidinemouthwash.• DiscardunusedChlorhexidine0.2%solution48hoursafteropening.• Informadoctorordentistwhenulcersorbleedingisseeninoralcavityand

administer medication as prescribed.• Visityourdentistforregularchecksatleastonceevery6months.

RecommendedWebsites1) HealthPromotionBoardWebsiteonOralHealth: http://www.hpb.gov.sg/HOPPortal/healthtopic/Oral%20Health 2) MinistryofHealthNursingGuidelinesforOralHygiene: http://www.moh.gov.sg/content/dam/moh_web/HPP/Nurses/cpg_nursing/2004/

nursing_management_of_oral_hygiene.pdf 3) NationalDentalCentreWebpageonDenturesandDentureCare: http://www.ndc.com.sg/ForPatientsAndVisitors/ConditionsAndTreatments/

Glossary/Pages/Dentures.aspx

Allinformationisvalidatthetimeofprinting(May2013) andsubjecttorevisionwithoutpriornotice.

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