evidence based mouth care policy - Doncaster and Bassetlaw ...

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• STANDARD MOUTH CARE Page 10 of 21 REF: PAT/PA 17 v.1 From the literature reviewed, the authors recognise the importance of regular oral hygiene (Turner 1995, Buglass 1995, Thurgood 1994, Kite and Pearson 1995). Buglass (1995) argues that frequency is more important than the agents used. Basic standard mouth care – (Literature states that the frequency of carrying out basic mouth care is more important than the agents which are used to facilitate mouth care) Buglass EA 1995 Oral Hygiene British Journal of Nursing 4 (a) 516-519. Guidelines for Oral Care BDA April 2000. Guidelines for Record Keeping (2002). London Nursing and Midwifery Council. There is however, no general agreement regarding how frequently care should be given or the tools and agents which should be used. (Buglass 1995). For the purpose of our guidelines we have agreed standard care entails 12 hourly tooth brushing using a soft brush and toothpaste as research suggests the massaging effect of a soft brush stimulates mucosa promoting healthy gums. It is also the most effective way to loosen debris and remove plaque without causing trauma providing that care is taken (Thurgood 1994), Ransier et al 1995, Kite and Pearson 1995). Rinsing well with warm water is important as any remaining toothpaste may have a drying effect. Toothpaste gives a pleasant taste; always use a fluoride paste or Corsodyl gel if gingivitis is present. For patients with dentures the literature states all dentures should be removed overnight to prevent shrinkage. Debris must be removed as candida may be present and be harboured in the dentures therefore prevents introducing/ reintroducing infection. Dentures should be stored in a clean, dry container. Evidence suggests reassessment of the oral cavity should occur every 12 hours to ensure ongoing care is maintained. The flowchart should be used to aid assessment. Patient Requiring Assistance Often patients require assistance with oral hygiene. Standard mouth care should be maintained. In addition, water soaked swabs may be required to keep the mouth moist. Suction may also be required to remove excess secretions. The use of soft paraffin ointment to the lips will keep them moist and prevent them from drying and cracking. (Turner 1995). Somerville (1999) suggests nurses, in particular intensive care nurses, are fearful of using tooth brushes especially in intubated patients preferring to the use of sponge sticks. However, this is not effective in the removal of plaque and debris. There is also the danger of the sponge becoming separated from the stick. Therefore sponge sticks are not recommended. Ulceration If ulceration is present, but there is no candida coating the tongue teeth or mucosa, Difflam mouthwash should be used in addition to standard mouth care. Difflam enhances oral care as it contains a topical anaesthetic and has anti-inflammatory and anti-microbial properties (Thurgood 1994). However, it has numbing analgesic effect and must be prescribed by medical staff.
Coated Tongue, Teeth or Mucosa Page 11 of 21 REF: PAT/PA 17 v.1 If the tongue, teeth or mucosa are coated and candida is present, anti-fungal preparations must be used along with standard care and Difflam mouth wash. Nystatin or amphoterecin act on the candida. These must also be prescribed by medical staff. When candida is present it may also be harboured in the patient’s dentures. (Buglass 1989). The Trust Infection Control Team suggests brushing dentures at least four hourly in addition to the half hour soaking in milton to reduce this problem. If there is no candida present carefully brushing the tongue with chlorhexidene solution and the teeth with corsodyl gel is suggested. The acts by preventing the development and build-up of plaque and also has an anti-microbial effect (Kite and Pearson 1995, Thurgood 1994). Pineapple chunks contain a proteloytic enzyme, annase, which helps remove adherent coatings any may be used to remove the coating (Regnard 1898). Vitamin C tablets work by having an effervescent effect when placed on the tongue also aid in removing coating however there is limited research on its effect. Care must be taken in patients receiving radiotherapy/chemotherapy. Dry Mouth (Xerostomia) Saliva products - see below If the patient’s mouth is dry, it is important to treat the cause. Thurgood (1994) states that artificial saliva can be used without any detrimental effect and, is particularly useful in patients with impaired saliva production. Thurgood (1994) and Buglass (1989) suggest ice cubes, pineapple chunks and ice lollies may provide comfort as will using soft paraffin to moisten lips. Frequent sips of cold water, milk or sugar free, non acidic cool drinks will help. Gel Clair provides a protective coating if eating and drinking is painful. Xerostomia is the prime effect of severe and rapid dental decay (Gelbart 1998). Sweeney (1998) notes that, it can often lead to oral fungal infection. This is found in connective tissue complaints, such as Reiter’s syndrome, as well as in menopausal women and HIV patients. Painful Mouth If on assessment the patient has a painful mouth it is important to determine the cause. This could be due to ill fitting dentures, radiotherapy, chemotherapy, or infection. Topical analgesics are effective along with standard mouth care in relieving pain. Difflam as described earlier has an antiinflammatory effect. Bongela has a local numbing effect (Thurgood 1994) Mucositis (inflammation of the mouth) is painful and an extremely unpleasant side effect of some cancer treatments. It has an acute phase usually due to chemotherapy or radiotherapy to the oral cavity. Normal tooth brushing should continue using a soft toothbrush if possible; alternatively chlorhexidene mouth wash can be used. It should be used 3-4 times daily. It helps with plaque control although its value in reducing symptoms of mucositis is less clear. Very few therapies have been used in randomised prospective trials. Recent evidence suggests that the use of an antibiotic lozenge may reduce the most severe symptoms of mucositis. Experimental evidence supports the use of Gel Clair in the first instance In normal saliva production we produce 1-2mls per minute. 80% is from the Parotid Gland. Saliva is anti-bacterial and anti-fungal and helps maintain oral PH for food digestion.
Page 1 and 2: EVIDENCE BASED MOUTH CARE POLICY De
Page 3 and 4: • INTRODUCTION Page 3 of 21 REF:
Page 5 and 6: • DRUGS AND TREATMENTS Page 5 of
Page 7 and 8: • ASSESSMENT AND ACTION REQUIRED
Page 9: Additional Information Page 9 of 21
Page 13 and 14: Page 13 of 21 REF: PAT/PA 17 v.1
Page 15 and 16: Indirect effects of secondary to my
Page 17 and 18: REFERENCES Page 17 of 21 REF: PAT/P
Page 19 and 20: ORAL ASSESSMENT TOOL Page 19 of 21
Page 21: The Oral Cavity and Oropharynx Page

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