Oral Care in Nursing: Step-by-Step Procedure, Guidelines, and OSCE Tips

Oral hygiene is the process of keeping the patient’s mouth clean by brushing to prevent mouth infection, odour, and improve patient comfort. Proper oral hygiene enhances patient comfort, appetite, and communication
, and overall health, especially in bedridden, unconscious, and critically ill patients

Indications for Oral Care in Nursing

• to prevent oral infection that can come as a result of poor oral care
• to treat oral infection like candida, oral odour
• preventing the oral mucous membrane from becoming dry and cracked
• to maintain oral hygiene among bedridden patients 
• to provide comfort to both the nurse and the patient when communicating
• to prevent sores that result in ulcerations
• prevent dental caries and tooth decay
• prevent complications like glossitis, stomatitis
• stimulate circulation in the gum, thus maintaining healthy firmness
• increases appetite in a patient who has lost appetite
• stimulate salivation. increase the production of saliva to keep the mouth moist
• to remove food that has remained in the teeth after eating
• prevent bad breath, i.e., halitosis

Patients Who Require Oral Care

• patients who are unconscious or semi-conscious.
• paralysed patient because they are helpless to themselves.
• A patient with acute illness and a seriously ill patient.
• post-operative patient after anaesthesia.
• pre-operative patient,  especially a patient having an operation in the mouth.
• patient with higher pyrexia
• A patient on nil per os, i.e., the patient is not taking anything by mouth.
• A patient with malnutrition to boost their appetite
• A patient with local disease of the mouth, e.g., oral thrush, gum infections
• paraplegic patient
• dehydrated patient.

Complications of Poor Oral Hygiene

Local Complications

• Stomatitis (inflammation of the oral mucosa)
• Gingivitis (gum inflammation)
• Glossitis (tongue inflammation)
• Dental caries (tooth decay)
• Root abscess
• Periodontal disease (pyorrhea)
• Bleeding gums

Complications of Nearby Structures

• Parotitis (parotid gland inflammation)
• Rhinitis (sinus inflammation)
• Otitis media (middle ear infection)
• Tonsillitis Adenitis

Systemic Complications

• Anorexia (loss of appetite)
• Bacterial endocarditis
• Gastritis
• Nephritis
• Rheumatic arthritis

Equipment for Oral Care Procedure

a tray containing the following

1. a galipot of sodium bicarbonate
2. a galipot of glycerine and borax
3. container for artery forceps and non-tooth dissecting forceps (two artery forceps and two non-tooth dissecting forceps.
4. galipot of cotton
5. a receiver for a used glove
6. a receiver for a used mouthpiece
7. a receiver for wastewater
8. a bottle of sodium bicarbonate
9. a bottle for glycerine and borax
10. a glass of water or mouthwash
11. mouthpiece in a galipot
12. mouth gag
13. tongue depressor
14. glove
15. a Mackintosh and a towel.
16. apron
17. mask
18. a bowl of denatured if needed

bed side

1. screen
2. hand washing equipment

Procedure for Oral Care in an Unconscious Patient

1. explain the procedure to the patient and attendant for easy cooperation and trust building
2. provide privacy using the screen, providing comfort
3. Bring the tray to the bedside for easy access to the equipment
4. Position the patient in a sitting-up position 
5. Place the Mackintosh and the towel at the head of the patient to protect the patient’s bedding and clothes.
6. Wash your hands and put on gloves to protect both the nurse and the patient from cross-infections.
7. Remove the patient’s denature if the patient has them, clean and put them in the bowl of water.
8. Open the mouth using a mouth gag
9. Using a tongue depressor, depress the tongue from falling back to block the airway
10. Inspect the mouth note and report any abnormalities
11. Pick the cotton using artery forceps and dip it in the cleaning solution(sodium bicarbonate)
12. Squeeze it using non-toothed dissecting forceps to prevent dripping.
13. clean the outer and the inner surface of the teeth and change the cotton
14. clean the gum and change the cotton
15. clean inside the cheek and change the cotton
16. clean the tongue gently
17. clean the teeth from the root up ward but avoid touching the soft palate
18. Rinse the mouth.
19. Wipe the lips with a dabbing movement and apply glycerine
20. Thank the patient and leave the patient comfortably
21. clear away
22. document

conclusion

Oral care in nursing is a vital procedure that helps prevent infections, improve patient comfort, and promote overall health. Nurses must follow proper techniques, infection control measures, and use appropriate equipment to ensure safe and effective oral hygiene for both conscious and unconscious patients.

FAQ on oral care nursing procedure