PROCEDURES IN BRUSHING THE TEETH

ORAL CARE

Oral care and basic hygiene are fundamental client care tasks.

ORAL HYGIENE

- is the mechanical action of brushing that removes food particles that can harbor
and incubate bacteria.
- It also stimulates circulation in the gums; thus, maintaining their healthy
firmness.

Who needs oral hygiene?

Certain clients are prone to oral problems because of lack of knowledge or the
inability to maintain oral hygiene.
§ seriously ill, confused, comatose, depressed, and dehydrated clients
§ clients with nasogastric tubes
§ clients with oxygen therapy
§ after oral or jaw surgery-needs meticulous oral care to prevent the development
of infections
§ elderly people
§ healthy people

PURPOSES OF ORAL CARE:

1. To prevent formation of sores.

2. To cleanse the mouth and keep its mucous membrane in good condition.
3. To prevent dental carries.
4. To prevent halitosis.
5. To minimize bacterial flora, in order to prevent infection.

Special Considerations on Oral Hygiene:

1. If the patient’s condition allows, encourage him to brush his teeth.

2. Carry out oral care measures as part of daily routine care.
3. Observe special precautions when cleaning the mouth of a very ill patient.
4. Handle dentures with care to prevent loss or damage.
5. If antiseptic mouthwashes are to be used, follow correct dilution.
 STEPS IN BRUSHING THE TEETH

1. Hold the brush against the teeth This sulcular technique removes
with the bristles at a 45 degree plaque and cleans under the gingival
angle. The tips of the outer margins.
bristles should rest against and
penetrate under the gingival
sulcus. The brush will clean
under the sulcus of two or three
teeth at one time.

2. Move the bristles back and

forth using vibrating or jiggling
motion, from sulcus to the
crowns of the teeth.

3. Repeat until all outer and inner

surfaces of the teeth and sulci
of the gums are cleaned.

4. Clean the biting surfaces by

moving the brush back and
forth over them in short
strokes.

5. If the tongue is coated, brush it Brushing removes accumulated

gently with the toothbrush. materials and coatings. A coated
tongue may be caused by poor oral
hygiene and low fluid intake. Brushing
gently and carefully helps prevent
gagging or vomiting.

6. Hand the client the water cup Vigorous rinsing loosens food
or mouthwash to rinse the particles and washes out already
mouth vigorously. Ask the loosened particles.
client to spit the water and
excess dentrifice into the basin.

7. Repeat the steps above until

the mouth is free of dentrifice
and food particles.

8. Remove the curved basin, and

help the client wipe the mouth.
 FLOSSING THE TEETH

It removes plaque and food particles in places where a toothbrush cannot easily
reach — under the gumline and between the teeth. Because plaque build-up can lead to
decay and gum disease, daily flossing is highly recommended.

STEPS in FLOSSING THE TEETH:

1. Wrap one end of the floss around the third finger of each hand.

2. To floss the upper teeth, use the thumb and index finger to stretch the floss.

ü Move the floss up and down between the teeth from the tops of the crowns
to the gum and along the gumlines as far as possible.

ü Make a “C” with the floss around the tooth edge being flossed.

ü Start at the back on the right side and work around the back of the left
side, or work from the center teeth to the back of the jaw on either side.

3. To floss the lower teeth, use your index fingers to stretch the floss.
4. Give the client tepid water or mouthwash to rinse the mouth and a curve basin in
which to spit the water.
5. Assist the client in wiping the mouth.

THE PATIENT WITH DENTURES

1. Persons wearing dentures are usually very sensitive about it and would like to do
the cleaning themselves. Dentures are valuable in cost and convenience. Most
people prefer to clean themselves if they are able.
2. If dentures are removed, store them in an opaque container and keep them in a
safe place.
3. Promotes safety for the denture, so that it does not get lost or thrown away.
4. Provide privacy.

The Patients with Dentures

- kidney basin - toothpaste
- toothbrush - glass of water
- towel - gauze
- tissue wipes
 Procedure Rationale

1. Wash hands. Handwashing deters the spread of

microorganisms.

Organization of task facilitates easy

2. Arrange supplies on bedside performance of work.
table.
Use as container for dentures.
3. Pour emesis basin half full with
tepid water.

4. Ask client to remove his or her Removing dentures facilitates its

dentures and place them in proper cleaning.
emesis basin.
Proper removing of dentures
If client is unable to remove prevents pain and discomfort on the
dentures, grasp upper plate at patient.
front with thumb and index
fingers wrapped in gauze. Dentures break easily if dropped on a
board surface.
Use steady downward pull.
Gently lift lower denture from
jaw and rotate one side
downward to remove from
client’s mouth.
Place dentures in emesis basin.
5. Apply toothpaste to toothbrush Toothbrush are
and brush all surface of devices to help clean
dentures. small area and creases
Hold dentures close to water. of the dentures.

Hold brush horizontally and

use back and forth motion to
cleanse biting surfaces.

Hold brush vertically and use

back and forth motion to clean
undersurface of dentures.

6. Rinse dentures thoroughly Never use hot water since excessive

in tepid water. heat might melt the dentine material.

7. Return dentures to client or Soaking dentures prevents it from

store in tepid water in denture’s drying and keeping it clean.
cup. Wash hands.

8. Empty emesis basin and add Promotes thorough cleaning and

fresh cold water. Apply toothpaste prevents formation of soardes.
to soft toothbrush and gently brush
client’s gum, palate, and tongue.

9. Have client rinse his mouth To remove remaining food particles in

thoroughly. the mouth and proper rinsing gives a
clean and refreshing taste.

10.Reinsert dentures if client Proper application of dentures

desires. Begin by gently inserting promotes comfort to patient.
moistened upper denture. Have
client use finger to press denture
firmly in place, then insert lower
denture.

11. Ask client if dentures feel For patient’s safety and comfort.
comfortable.

12. Wash hands. Handwashing deters the spread of

microorganisms

CARE OF THE PATIENT WHO NEEDS ASSISTANCE

THE PATIENT CONFINED TO BED WHO NEEDS ASSISTANCE

- toothbrush - rubber sheet

- two (2) bath towels - glass of water
- kidney basin - half-glass of prepared
- mouthwash - dentrifice (paste or powder)
- petroleum jelly - drinking tube/straw
 PROCEDURE RATIONALE

1. Inform the patient about the To gain patient’s cooperation and to allay
procedure. fear.

2. Screen the bed if the patient is in a To provide privacy.

general ward.

3. Place the patient in a semi-sitting To prevent choking and aspiration of

position. solution during the procedure.
(For the patient who must remain flat
in bed, turn the head to one side, and
protect the pillow with a rubber sheet
and a towel).
Protect the patient’s gown from getting
4. Place the towel across the patient’s wet and soiled
chest. Don gloves.
Toothpaste promotes proper cleaning of
5. Put some toothpaste on the toothbrush the teeth.
and hand it to the patient. Wash hands.

6. Hold the kidney basin close to the Waste receptacle for the gargled water
chin.
Initial washing of the mouth helps loosen
7. Offer a glass of water and allow the the food particles between the teeth.
patient to wet his mouth.
Teeth are cleaned by friction and prevent
8. If the patient can, allow him to do the the development of dental caries.
brushing. Assist him if necessary.
Washes away the used toothpaste and
9. Offer a glass of water and allow the food particles in the mouth.
patient to rinse his mouth

10. Offer a glass of mouthwash and Mouthwash creates a clean, refreshing

allow the patient to gargle. taste.

11. Dry the lips with the towel. Apply Dry and cracked lips provide a portal of
petroleum jelly if necessary. entry for infection. Do not use mineral oil
as there is danger of aspiration.

12. Clean all used articles and return Proper after care of equipments provide a
them to proper places. Discard mouth neater environment. Proper disposal of
rinsing direct to the drain or toilet bowl. waste
Prevents the spread of microorganism.
 PATIENT WHO IS UNRESPONSIVE

Equipments:
- mouthwash in enamel cup or medicine glass
- cotton-tipped applicators
- several wooden tongue depressors wrapped with gauze secured by adhesive tape
- kidney basin
- rubber sheet
- two (2) bath towels
- suction apparatus
- petroleum jelly

PROCEDURE RATIONALE
1. Inform the relatives about the To allay fear and apprehension on
necessity of the procedure. the part of the relatives.

2. Screen the bed if the patient Provide privacy.

is in general ward.

3. Protect the pillow with a Prevents soiling and wetting the

rubber sheet and a towel. flow.

4. Turn the patient’s head to one This position prevents

side with the face slightly choking and aspiration solution
downward. during the procedure.

5. Drape the towel across the Prevents the patient gown from
chest. soiling or wetting.

6. Dip the gauze wrapped This is used to brush and clean the
tongue depressor in the teeth.
mouthwash solution.

7. Insert a gauze wrapped Do not use bare hands to open

tongue depressor to keep the patients mouth, the unconscious
mouth open. patient may bite down the nurse
finger.

8. Using the wet tongue The friction of brushing, not

depressor, clean the buccal toothpaste, cleans teeth, so no
cavity starting from the toothpaste is needed.
inner cheeks; then the teeth,
 tongue and towards the lips.

9. Suction excess solution. To avoid choking, by removing

excess accumulated solution in the
mouth.

10. Apply petroleum jelly to the Prevents lips and mucous

lips and mucous membrane membranes from drying.
of the mouth with cotton
applicator