Providing Special Oral Care For the Unconscious Client

Purposes:
- To maintain the intactness & health of the lips, tongue & mucous membrane of the mouth.
- To prevent oral infections
- To clean & moisten the membranes of the & lips.

Equipment:
- Towel
- Curved basin
- Disposable clean gloves
- Tissue or piece of gauze
- Mouthwash
- Bite block to hold the mouth open & teeth apart
- Suction catheter with suction apparatus when aspiration is a concern
- Toothbrush
- Cup of tepid water
- Dentrifice
- Denture container
- Rubber tip bulb syringe
- Foam swabs & cleaning solution for cleaning the mucous membrane
- Water soluble lip moisturizer

Procedure
1. Introduce yourself.
2. Perform hand hygiene
3. Provide privacy
4. Prepare the client

- Position the client in a side-lying position w/ thehead of the bed lowered. – In this position the saliva automatically runs out of gravity rather than being aspirated into the lungs. This position is chosen for the uconscious client receiving mouth care. If the clients head cannot be lowered turn it to one side. – The fluid will readily run out of the mouth or pool in the side of mouth where it can be suctioned.

- Place the towel under the clients chin

- Place the curved basin against the client’s chin and lower check to to receive the fluid from the mouth.

- Put on gloves

5. Clean the teeth & rinse the mouth

- If the person has natural teeth brush gently & carefully to avoid injuring the gums. If the client has artificial teeth clean it the way w/ the dentures.

- Rinse the client’s mouth by drawing about 10ml of water or alcohol free mouthwash into the syringe & injecting it gently into each side of the mouth. – If the solution is injected w/ force, some of it may flow down the client’s throat & be aspirated into the lungs.

- Watch carefully to make sure that all the rinsing solution has run out of the mouth into the basin. If not suction the fluid from the mouth. – Fluid remaining in the mouth may be aspirated into the lungs.

- Repeat rinsing until the mouth is free of dentrifice, if used.

6. Inspect & clean the oral tissues.

- If the tissues appear dry or unclean, clean them w/ the foam swabs or gauze & cleaning solution following agency Policy.

- Picking up moistened foam swab, wipe the mucous membrane of one cheek. Discard the swab in a waste container, use a clean one to clean the next area. – Using separate applicators for each area of the mouth prevents the transfer of microorganisms from one area to another.

- Clean all mouth tissues in an orderly progression, using separate aplicators. The cheeks, roof of the mouth, base of the mouth & tongue.

- Observe the tissues, for inflammation & dryness

- Rinse the client’s mouth

- Remove & discrad the gloves.

7. Ensure client comfort.

- Remove the basin & dry around te client’s mouth w/ the towel. Replace artificial dentures.

- Lubricate the client’s lips w/ water-soluble moisturizer. – Lubrication prevents cracking & subsequent infection.

8. Document assessment of the teeth, tongue, gums & oral mucosa. Include any problems such as sores, or inflammation & swelling of the gums.