The University of Jordan
Faculty of Nursing
Procedure:Oral Hygiene for Unconscious or Debilitated Patient.
Purpose (s):Unconscious patients are susceptible to drying of mucous-thickened salivary secretions
because they are unable to eat or drink, frequently breathe through the mouth, and often receive
oxygen therapy. Proper oral hygiene requires keeping the oral mucosa moist and removing
secretions that lead to infection. The unconscious patient cannot swallow salivary secretions that
accumulate in the mouth. These secretions commonly contain gram-negative bacteria that cause
pneumonia if aspirated into the lungs. Routine suctioning of the mouth and pharynx may be
required to manage oral secretions to reduce the risk for aspiration.
Preparation
1. Assemble equipment and supplies:
•Small soft-bristle toothbrush or a foam stick applicator
•Antimicrobial rinse (e.g., chlorhexidine)
•Fluoride toothpaste
•Water-based mouth moisturizer
•Small bulb syringe or suction equipment (optional)
•Oral airway
•Water-soluble lip lubricant
•Water glass with cool water
•Face towel
•Paper towels
•Emesis basin
•Clean gloves
2.Provide privacy for the patient.
3.Explain the procedure to the patient, even if he or she is unconscious.
Do not assume that an unconscious person is unable to hear; always explain procedures to the
patient
4.Place paper towels on the over-bed table, and arrange supplies.
5.If needed, turn on suction machine, and connect tubing to suction catheter.
Procedure
1.Perform hand hygiene.
2.Verify the correct patient using two identifiers.
3.Raise bed to appropriate height for the nurse; lower side rail.
4.Unless contraindicated (e.g., head injury, neck trauma), position the patient on side (Sims
position) with head turned well toward dependent side and head of bed lowered.
5.Place a towel under the patient’s head and an emesis basin under the chin.
6.Perform hand hygiene and don gloves while remaining at the bedside.
7.Remove the patient’s dentures or partial plates, if present.
8.Insert an oral airway if the patient is unable to cooperate or keep the mouth open. Insert it when
the patient is relaxed, if possible. Insert the airway upside down, then turn it sideways and
position it over the tongue to keep the teeth apart. Do not use force.
9.Clean the mouth/teeth using a small, soft-bristle toothbrush moistened in water if the patient can
tolerate brushing. A water-moistened foam stick applicator may be used if the patient has
sensitive gums
a.Apply toothpaste or use antiinfective solution first to loosen crusts.
b.Clean chewing and inner tooth surfaces first, outer tooth surfaces next, using an up-and-down
gentle motion.
c.Use toothbrush or foam stick applicator to clean roof of mouth, gums, and inside of cheeks.
Gently brush tongue but avoid stimulating gag reflex (if present).
d.Rinse with water and repeat as needed.
e.Moisten toothbrush with antimicrobial mouth rinse and cleanse oral cavity, ensuring contact of
the antimicrobial rinse with all oral cavity structures.
f.Repeat antimicrobial rinsing several times if needed.
g.Use toothbrush or foam stick applicator to apply water-based mouth moisturizer.
Do not use lemon and glycerin swabs.
10.10.Suction secretions as they accumulate, if necessary.
11.Apply a thin layer of water-soluble moisturizer to the patient’s lips (Figure 2).
12.Inform the patient that the procedure is completed.
13.Discard supplies, remove gloves, and perform hand hygiene.
14.Reposition the patient comfortably, and return the bed and side rail to original positions.
15.Clean equipment and return it to its proper place.
16.Report any unusual findings to the practitioner.
17.Document the procedure in the patient’s record