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Oral hygiene for hospital patients
Oral hygiene for hospital patients
Alice A. Tronquet* R.D.H., B.S., Seattle Oral hygiene for the hospitalized, patient who is very ill is facilitated through use of a suction toothbrush developed at the University of Washington. The toothbrushing procedure is described. Interest in oral care and procedures to be carried out for hospital patients is be coming increasingly important. At least one dental hospital is already in opera tion,1 and the dental profession is en couraging general hospitals throughout the country to initiate better oral hygiene practices for all patients. Maintaining adequate oral care for hospital patients is difficult because hos pital personnel are already overworked. The physical limitations of many of the patients contribute to the lack of mouth care they receive. However, the patient who is unable to brush his teeth for long periods of time is acutely aware of his lack of oral hygiene. Also, staff members find the resulting mouth odors disagree able. Lack of adequate instructions in patient oral care will often discourage registered nurses from performing pro cedures which they are unsure of. To facilitate improved oral hygiene for the patient who is extremely ill, a suction toothbrush was recently tested at the University of Washington School of Dentistry. The faculty of the department
of dental hygiene, working with the de partment of oral surgery and the School of Nursing, used an idea suggested by Capp2 and developed a working model of the toothbrush. The suction toothbrush is an inexpensive, simple instrument for individual, hospital-patient mouth care (illustration). A small piece of flexible plastic tubing is inserted through a hole drilled in the head of the brush. The tubing extends from just below the level of the bristle tips down the handle of the brush to the suction apparatus. The tubing is held to the toothbrush handle by small rubber bands. The suction toothbrush, as assembled at the University of Washington,3 is adapted from a soft, multituft brush. A glass adapter or connector of the correct size for the hospital aspirator is fitted at the terminal end of the tube. The aspira tor is essential as it prevents mucin or loosened debris in the mouth from being inhaled or from blocking the air passages of the comatose patient. A demonstration given to the directors of the School of Nursing at the University of Washington Hospital showed how easy it would be to provide one of these toothbrushes for each patient incapable of using an ordinary brush. Usually, the brushing technic is modified to fit the condition of the individual patient. The tissues of the mouth of the long-term pa
48/214 • THE J O U R N A L O F THE A M E R IC A N DENTAL A S S O C IA T IO N
M u lt it u ft to o th b ru sh w ith su c tio n attachm en t. A : Plastic t u b in g . B: A d a p t e r fo r a tta c h m e n t o f t u b in g t o a s p ira t o r o r s u c tio n outlet. C : R u b b e r b a n d s t o a tta c h t u b in g t o to o th b ru sh h and le . P lastic t u b in g is in se rte d t h r o u g h a h ole in the h e a d o f the bru sh a n d e xte nd s to a level slig h t ly b e lo w the b ru s h in g plane.
tient are extremely sensitive, often hem orrhagic; therefore, a modified Charters’ toothbrushing technic is recommended.4 Slow, careful, gentle vibrations of the bristles remove the mucin which covers the teeth and gingiva of the chronically ill person. TECH NIC
The toothbrush should be shown to the conscious or semi-conscious patient and an explanation of the procedure should be given him. Even individuals who ap pear to be lethargic may become fright ened at unexpected movements.5 The toothbrushing procedure is as fol lows : 1. The patient should be told he is going to have his teeth brushed. He should then be turned on his side and a pillow placed at his back for support. A face towel should be placed under the patient’s chin and over the bedding. 2. The toothbrush is attached to the suction outlet and the brush laid on the towel near the patient’s mouth. 3. A rubber bite-block may be used. If so, it is placed between the teeth on one side of the patient’s mouth. The string tied to the bite-block should be
fastened to the patient’s gown with a pin to eliminate any possibility that the pa tient will swallow the bite-block. 4. The brush is dipped into a glass of warm water to soften the bristles. A flavored mouthwash may be added to the water to serve as a refreshant. 5. The patient’s cheek and lips on the side of the mouth opposite the bite block are retracted with the forefinger and the middle finger. Only the labial and buccal surfaces of the teeth and the gingiva are brushed. A Charters’ toothbrushing method or a gentle, modified rolling stroke, with gentle vibrations, should be used. The suction should be applied over each tooth surface and particular atten tion given to each interproximal area. The brush should be remoistened fre quently to remove the mucin from the bristles. The bite-block is moved to the opposite side of the mouth and the brush ing procedure is repeated on the other side of the mouth. 6. The bite-block is carefully removed from the patient’s mouth after all teeth have been brushed. The toothbrush is placed in a cup of clear water to clean the tubing and to remove the mucin from the bristles. The suction is then discon nected.
T R O N Q U ET . . . V O L U M E 63, A U G U ST 1961 • 49/217
The total welfare of the patient should good oral care and the procedures they always be of foremost importance. Mouth should use to assure oral comfort and care for the patient should therefore also cleanliness for patients. include care of the lips. Petroleum jelly may be used to moisten the lips and gingiva of a patient whose tissue has be come dry through illness.6 * D e p a r t m e n t o f d e n ia l h y g ie n e , U n iv e rs it y o f W a s h in g t o n .
School
of
1. S p e c ia l h o s p it a l fo r d e n t a l c a re . O r a l D e c . 1959.
COM M ENT
New equipment is being developed con tinually to advance mouth care for the hospital patient. The dental profession should initiate programs of oral health practices for the ill. Hospital personnel need to be alert to the importance of
2. C a p p , J a n e . T r a d in g N o v . 1958.
D e n tistry,
H y g . 49:29
p o st. A m . J . N u r s in g 58:1532
3. W ilk in s , E sth e r M ., a n d M c C u ll o u g h , P a t r ic ia A . C li n i c a l practice o f the d e n t a l h y g ie n is t . P h ila d e lp h ia , L e a & F e b ig e r , 1959, p. 273. 4. W ilk in s , E sth e r M ., a n d M c C u ll o u g h , P a t r ic ia A. C li n i c a l p r a c t ic e o f th e d e n t a l h y g ie n is t. P h ila d e lp h ia , L e a & F e b ig e r , 1959, p. 228. 5. in g ,
M c C l a i n , M . E sther. S c ie n t if ic p r in c ip le s e d . 2. St. L o u is, M o s b y , 1953, p. 405.
in
n u rs
6. G e h r ig , J o h n D. H o w t o c o n d u c t th e in itia l o ra l e x a m in a t io n o f t h e u n c o n s c io u s p a t ie n t. In H a n d b o o k f o r n u rse s. S c h o o l o f N u r s in g , U n iv e rs it y o f W a s h in g t o n , 1959.
Youth • Youth is not a time of life. It is a state of mind. It is not a matter of ripe cheeks, red lips, and supple knees; it is a temper of the will—a quality of the imagination—a vigor of the emotions. Nobody grows old by merely living a number of years—people grow old only by deserting their ideals. Years wrinkle the skin, but to give up enthusiasm wrinkles the soul. Worry, doubt, self-distrust, fear, and despair—these are the long, long years that bow the heart and turn the greening spirit back to dust. Whether 60 or 16, there is in every human being’s heart the lure of wonder, the undaunted challenge of events, the unfailing child-like appetite for what next, and the joy of the game of living. We are as young as our self-confidence, as old as our fear; as young as our desire, as old as our despair. Anonymous, quoted by Gerontological Research Foundation, April, 1960.
Alice A. Tronquet* R.D.H., B.S., Seattle Oral hygiene for the hospitalized, patient who is very ill is facilitated through use of a suction toothbrush developed at the University of Washington. The toothbrushing procedure is described. Interest in oral care and procedures to be carried out for hospital patients is be coming increasingly important. At least one dental hospital is already in opera tion,1 and the dental profession is en couraging general hospitals throughout the country to initiate better oral hygiene practices for all patients. Maintaining adequate oral care for hospital patients is difficult because hos pital personnel are already overworked. The physical limitations of many of the patients contribute to the lack of mouth care they receive. However, the patient who is unable to brush his teeth for long periods of time is acutely aware of his lack of oral hygiene. Also, staff members find the resulting mouth odors disagree able. Lack of adequate instructions in patient oral care will often discourage registered nurses from performing pro cedures which they are unsure of. To facilitate improved oral hygiene for the patient who is extremely ill, a suction toothbrush was recently tested at the University of Washington School of Dentistry. The faculty of the department
of dental hygiene, working with the de partment of oral surgery and the School of Nursing, used an idea suggested by Capp2 and developed a working model of the toothbrush. The suction toothbrush is an inexpensive, simple instrument for individual, hospital-patient mouth care (illustration). A small piece of flexible plastic tubing is inserted through a hole drilled in the head of the brush. The tubing extends from just below the level of the bristle tips down the handle of the brush to the suction apparatus. The tubing is held to the toothbrush handle by small rubber bands. The suction toothbrush, as assembled at the University of Washington,3 is adapted from a soft, multituft brush. A glass adapter or connector of the correct size for the hospital aspirator is fitted at the terminal end of the tube. The aspira tor is essential as it prevents mucin or loosened debris in the mouth from being inhaled or from blocking the air passages of the comatose patient. A demonstration given to the directors of the School of Nursing at the University of Washington Hospital showed how easy it would be to provide one of these toothbrushes for each patient incapable of using an ordinary brush. Usually, the brushing technic is modified to fit the condition of the individual patient. The tissues of the mouth of the long-term pa
48/214 • THE J O U R N A L O F THE A M E R IC A N DENTAL A S S O C IA T IO N
M u lt it u ft to o th b ru sh w ith su c tio n attachm en t. A : Plastic t u b in g . B: A d a p t e r fo r a tta c h m e n t o f t u b in g t o a s p ira t o r o r s u c tio n outlet. C : R u b b e r b a n d s t o a tta c h t u b in g t o to o th b ru sh h and le . P lastic t u b in g is in se rte d t h r o u g h a h ole in the h e a d o f the bru sh a n d e xte nd s to a level slig h t ly b e lo w the b ru s h in g plane.
tient are extremely sensitive, often hem orrhagic; therefore, a modified Charters’ toothbrushing technic is recommended.4 Slow, careful, gentle vibrations of the bristles remove the mucin which covers the teeth and gingiva of the chronically ill person. TECH NIC
The toothbrush should be shown to the conscious or semi-conscious patient and an explanation of the procedure should be given him. Even individuals who ap pear to be lethargic may become fright ened at unexpected movements.5 The toothbrushing procedure is as fol lows : 1. The patient should be told he is going to have his teeth brushed. He should then be turned on his side and a pillow placed at his back for support. A face towel should be placed under the patient’s chin and over the bedding. 2. The toothbrush is attached to the suction outlet and the brush laid on the towel near the patient’s mouth. 3. A rubber bite-block may be used. If so, it is placed between the teeth on one side of the patient’s mouth. The string tied to the bite-block should be
fastened to the patient’s gown with a pin to eliminate any possibility that the pa tient will swallow the bite-block. 4. The brush is dipped into a glass of warm water to soften the bristles. A flavored mouthwash may be added to the water to serve as a refreshant. 5. The patient’s cheek and lips on the side of the mouth opposite the bite block are retracted with the forefinger and the middle finger. Only the labial and buccal surfaces of the teeth and the gingiva are brushed. A Charters’ toothbrushing method or a gentle, modified rolling stroke, with gentle vibrations, should be used. The suction should be applied over each tooth surface and particular atten tion given to each interproximal area. The brush should be remoistened fre quently to remove the mucin from the bristles. The bite-block is moved to the opposite side of the mouth and the brush ing procedure is repeated on the other side of the mouth. 6. The bite-block is carefully removed from the patient’s mouth after all teeth have been brushed. The toothbrush is placed in a cup of clear water to clean the tubing and to remove the mucin from the bristles. The suction is then discon nected.
T R O N Q U ET . . . V O L U M E 63, A U G U ST 1961 • 49/217
The total welfare of the patient should good oral care and the procedures they always be of foremost importance. Mouth should use to assure oral comfort and care for the patient should therefore also cleanliness for patients. include care of the lips. Petroleum jelly may be used to moisten the lips and gingiva of a patient whose tissue has be come dry through illness.6 * D e p a r t m e n t o f d e n ia l h y g ie n e , U n iv e rs it y o f W a s h in g t o n .
School
of
1. S p e c ia l h o s p it a l fo r d e n t a l c a re . O r a l D e c . 1959.
COM M ENT
New equipment is being developed con tinually to advance mouth care for the hospital patient. The dental profession should initiate programs of oral health practices for the ill. Hospital personnel need to be alert to the importance of
2. C a p p , J a n e . T r a d in g N o v . 1958.
D e n tistry,
H y g . 49:29
p o st. A m . J . N u r s in g 58:1532
3. W ilk in s , E sth e r M ., a n d M c C u ll o u g h , P a t r ic ia A . C li n i c a l practice o f the d e n t a l h y g ie n is t . P h ila d e lp h ia , L e a & F e b ig e r , 1959, p. 273. 4. W ilk in s , E sth e r M ., a n d M c C u ll o u g h , P a t r ic ia A. C li n i c a l p r a c t ic e o f th e d e n t a l h y g ie n is t. P h ila d e lp h ia , L e a & F e b ig e r , 1959, p. 228. 5. in g ,
M c C l a i n , M . E sther. S c ie n t if ic p r in c ip le s e d . 2. St. L o u is, M o s b y , 1953, p. 405.
in
n u rs
6. G e h r ig , J o h n D. H o w t o c o n d u c t th e in itia l o ra l e x a m in a t io n o f t h e u n c o n s c io u s p a t ie n t. In H a n d b o o k f o r n u rse s. S c h o o l o f N u r s in g , U n iv e rs it y o f W a s h in g t o n , 1959.
Youth • Youth is not a time of life. It is a state of mind. It is not a matter of ripe cheeks, red lips, and supple knees; it is a temper of the will—a quality of the imagination—a vigor of the emotions. Nobody grows old by merely living a number of years—people grow old only by deserting their ideals. Years wrinkle the skin, but to give up enthusiasm wrinkles the soul. Worry, doubt, self-distrust, fear, and despair—these are the long, long years that bow the heart and turn the greening spirit back to dust. Whether 60 or 16, there is in every human being’s heart the lure of wonder, the undaunted challenge of events, the unfailing child-like appetite for what next, and the joy of the game of living. We are as young as our self-confidence, as old as our fear; as young as our desire, as old as our despair. Anonymous, quoted by Gerontological Research Foundation, April, 1960.