Published Dec 2, 2005
Nurse-o-Matic
151 Posts
There is a 40 year old patient in my ICU who was intubated 2 weeks and then trached. In total he has been in the ICU for about five weeks. The patient's family was upset that the patient's front teeth were decaying. I inspected this guy's choppers and noted copious areas of grey and black decay especially between the teeth. Does anyone know if decay really happens that fast? Either this patient had some dental issues prior to intubation or he is really susceptible to dental carries. Our policy is Q 4 hour chlorahexidine rinse and swabs and since the patient has been trached (past three weeks) he gets his teeth brushed twice daily.
Anyone out there flossing your vented patients?
Phishininau
110 Posts
I think this guy probably had some tooth issues when he came in. I dont really think that his teeth will decay in two weeks. I am sure though, if you were prying on them with the laryngoscope you may have broken off the already rotten ones. Just a thought....
Teeth make me sick though...especially the ones that we generally see.
trishtravelsrn
13 Posts
Our ICU policy to prevent Ventilator aquired pneumonia is q4h oral care. I do take care of my patient teeth with the rinses and suction frequently. We have seen teeth fallout after several weeks on the vent. It is unusual but does happen. Ususally to ETOH abuser or drug abuser.
That's pretty much what I thought...teeth were probably already crummy prior to intubation--but family is insisting this is not the case and are really upset. I hope someone did some charting on the teeth at admission if they were, in fact already in poor condition.
Our protocol calls for Q2 mouth care, and I am sure that is more often than some of these people do at home!
marissa81579
29 Posts
BRUSH THEIR TEETH!!!!! WITH A REAL BRUSH!!!! That is what the newest research shows. Don't wait til they are extubated or trached people! Do you really think the sponges with some diluted mouthwash get stuff clean? Not so much!
pricklypear
1,060 Posts
I can't recall ever having a pt in our unit come in with perfect teeth only to have them rot out within 5 weeks. Most of our patients who end up being long term vent pts had medical problems to begin with, and poor dentition to boot. It's also true that he may have had some trauma during the original intubation that caused the teeth to eventually die. It's a bummer, but the guy sounds like he has bigger problems than a couple of missing front teeth
Zee_RN, BSN, RN
951 Posts
I cannot agree more! I just **wish** we were given adequate toothbrushes! I've been known to buy toothbrushes myself for intubated patients. We get those general issue toothbrushes that are way too big to fit in the mouth next to a endotube and do an adequate job. I'll buy soft, small-headed toothbrushes and bring them to work. Obviously, I can't do this too much; they're not cheap (but I'm sure the ones the hospital provides are!).
Oral care is a big issue in preventing VAP, not to mention general tooth decay and other issues.
kersti
112 Posts
On my unit it is common procedure to brush teeth at least twice a day, with multiple swabbings in between with different rinses(depending on what the gums, tongue) looks like. I even like to make a fresh peppermint tea and use that as a rinse- pts. who are more awake usually really appreciate that. At our facility, the toothbrush quality isn't that great- so we ask family/friends if there are any, to bring in a toothbrush. We don't floss. Never heard of teeth rotting that quickly unless there was a problem to beginn with.