Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬

Ministry of Education ‫وزارة التعليم‬

Jouf University ‫جامعة الجوف‬
University Vice Rectorate for ‫وكالة الجامعة للشؤون‬
‫التعليمية‬
Academic Affairs

Fundamental of Nursing (1) Basic Clinical Skills

Provide Oral hygiene
Definition:
Maintaining daily oral hygiene, including brushing, flossing, and
rinsing, is essential for preventing and controlling plaque-
associated oral diseases.
Purpose:
To preventing inflammation and infection, oral hygiene promotes
comfort, nutrition, and verbal communication.
Equipment:
•Soft-bristle toothbrush (hard toothbrushes damage enamel and
gums)
•Nonabrasive fluoride toothpaste or dentifrice
•Dental floss
•Tongue depressor
•Water glass with cool water
•Normal saline or an essential-oil antiseptic mouthwash (optional;
follow
patient’s preference)
•Emesis basin
•Face towel
•Paper towels
•Clean gloves
Procedure:
NO Steps Rationale and
Illustrations
1. Perform hand hygiene before
patient contact.
2. Introduce yourself to the patient.
3. Verify the correct patient using
two identifiers.
4. Assess the patient’s risk for oral
hygiene problems.
a. Dehydration
b. Inability to take fluids or
food by mouth
c. Presence of nasogastric or
oxygen tubes
d. Mouth breathing
e. Chemotherapy drugs and
other medications (e.g.,
antihistamines, phenytoin,
antibiotics)
f. Radiation therapy to head
and neck
g. Coagulation disorders (e.g.,
leukemia, aplastic anemia)
h. Oral surgery; trauma to
mouth
i. Advanced age
j. Chemical injury
k. Diabetes mellitus
l. Artificial airway
5. Determine the patient’s oral
hygiene practices and
willingness to attend to hygiene
needs.
Frequency of tooth brushing and
flossing.
Type of toothpaste used
Last dental visit
Frequency of dental visits
Type of mouthwash used
6. Assess the patient’s ability to
hold and manipulate the
toothbrush.
7. Perform hand hygiene and done
gloves.
8. Explain the procedure to the
patient and ensure that he or she
agrees to treatment.
9. Raise the head of the bed, if
permitted, and lower the side
rail.
10. Assist the patient to move closer
to the side of the bed or to
assume a side-lying position.

If the patient is not bedbound,

assist him or her to a comfortable
position.
11. Place a paper towel over the
patient’s chest.
12. Using a tongue depressor,
inspect the integrity of the lips,
teeth, buccal mucosa, gums,
palate, and tongue, and check for
the gag reflex.

Instruct the patient not to bite

down.
13. Assess the patient for pain
during inspection of the oral
cavity.
14. Identify the presence of common
oral problems:
1) Dental caries: Chalky white
discoloration of tooth or
presence of brown or black
discoloration
2) Gingivitis: Inflammation of
gums
3) Periodontitis: Receding gum
lines, inflammation, gaps
between teeth
4) Halitosis: Bad breath
5) Cheilosis: Cracking of lips
6) Stomatitis: Inflammation
(may include mucositis and
infection) of the oral tissue,
including dentition, mucosa,
 and periodontium
7) Oral mucositis: Inflammation
of oral mucosa from
chemotherapy or radiation
therapy administration
8) Leukoplakia: White or gray
patches on the tongue, inside
of the cheek, or on the floor of
the mouth caused by long-
term irritation
9) Xero stomia: Dry mouth
15. Apply toothpaste to toothbrush
bristles while holding the brush
over the emesis basin. Pour a
small amount of water over the
toothpaste.
16. Brush the patient’s teeth or assist
the patient in brushing.
Hold the toothbrush bristles at a
45-degree angle to the gum line
(Figure 1A)
Clean the biting surfaces of the
teeth by holding the top of the
bristles against them and
brushing gently back and forth
(Figure 1B)
Brush inner and outer surfaces of
the upper and lower teeth by
brushing from the gum to the
crown of each tooth.
Brush the sides of the teeth by
moving bristles back and forth
(Figure 1C).
17. Have the patient hold the brush
at a 45-degree angle and lightly
brush over the surface and sides
of the tongue. Caution him or her
to avoid initiating the gag reflex.
18. Allow the patient to rinse the
mouth thoroughly with water.
 Have the patient take several sips
of water (or use a straw), swish
water across all tooth surfaces,
and spit into the emesis basin.

Use this time to teach the patient

the importance of brushing teeth
twice a day.
19. Allow the patient to floss between all
teeth (Figure 2). Assist the patient as
necessary.

a. Direct the patient to insert the

floss between two teeth and to
hold it against each tooth while
moving it up and down against
the sides of the tooth.
b. Instruct the patient on the
importance of daily flossing.

20. Have the patient rinse the teeth with

therapeutic mouth rinse, then spit the
rinse into the emesis basin.
21. Assist in wiping the patient’s mouth.
22. Assist the patient to a comfortable
position.
23. Remove the emesis basin and the
overbed table, raise the side rail if
appropriate, and lower the bed to its
original position.
24. Wipe the overbed table and return
equipment to the proper place.
25. Assess, treat, and reassess pain.
26. Discard supplies, remove gloves, and
perform hand hygiene.
27. Document the procedure in the
patient’s record. Report any abnormal
findings to the practitioner.