oral care on confused patients??

sunnycalifRN · Dec 1, 2009

You do the best you can. Sometimes you can only do oral care on the outside of the teeth and the outer gums. If a patient clenches his teeth, it's very hard to get the jaw open. Once in a while, I have been able to get the patient to do the oral care him/herself. When you try to do it, the confused patient's normal reaction is to clench.

woodyma · Dec 1, 2009

Have him do it himself, with you standing there kind of reminding him how, sometimes it works.

Sewbusy~RN · Dec 1, 2009

Have you tried a sage oral care kit? The cleaner might get around the teeth better and you won't have to worry about aspiration.

CABG patch kid, BSN, RN · Dec 1, 2009

As hard as it sounds, you should try everything you can to get in there, whether it be using a bite block of some kind or getting him to do it himself. I read an article in AJN about a pt who had such hard gunk in his mouth that it broke off and he aspirated and died from it. Extreme scenario but a very real possibility. But just the fact that you are posting here shows you care, so just keep trying!!

ktwlpn, LPN · Dec 1, 2009

Mouth care is such a challenge in this population.If you are in LTC you probably are not permitted to use a bite block. Has the nurse/physician checked the tongue? It could be thrush.. Can you hold his hand with the brush in it? If you can get him to do that try bringing the brush towards his mouth-start first by going through the motions of brushing-over time this may waken a memory and allow you to "assist" him with brushing-It takes time but I have seen it work. The biggest challenge is helping the family (and his caregivers) accept the fact that he is the later stages of the disease. Pneumonia from the bacteria in his mouth in minor compared to what is coming.They loose the ability to swallow-they can't manage their own secretions-and they often do get pneumonia and die from it.If the family is realistic he'll be on hospice and you will keep him as comfortable as possible. If care upsets him then you lower your care standards at this point.Keep him reasonably clean and dry.Does he fight during all care? Try giving him a couple of wash clothes to hold in each hand-he may concentrate his energies on them instead of you. We have a sticky thread on the LTC forum with lots of tips for dealing with the dementia resident-check it out..

AnnieRN2B · Dec 2, 2009

I'm transitioning from a career in Dental Hygiene to RN. Biofilm! Although Candida, Hairy Leukoplakia, or just plain dry mouth/ xerostoma from the meds could be causing problems here too. There are Dentists or RDH's in alternative practice here in California who will treat the patient right in the facility-They bring in everything needed to clean teeth, fillings, etc... Sedation.... In the mean time "Peroxyl" a peppermint flavored Peroxide mouth wash diluted with water 50%/50% and applied to what ever teeth and the tongue the patient will let you brush will help lower the bacterial count. Oasis also has a great tx line you can find @ Walmart or a well stocked Pharmacy. There have mouth washes, toothpaste, sugarless mints, and oral creams that help retain oral moisture and good Ph... It can really help with xerostoma. Just make sure you use the softest toothbrush you can find.

There is a type of mouth prop called a "Moult" mouth prop, they work great on a COOPERATIVE pt, but may dislocate a mandible on a combative pt with dementia. Other simpler mouth props may end up aspirated... http://www.wihd.org/dental/dental_products_adult_props.html

Might try oral care at mid day or another time of day ...but in an ideal situation, having a dentist or RDH come in do a gross debridement will make it easier to keep the pt's mouth clean.