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3-Overcoming Barriers to Good Care
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Section Completed! Gag Reflex
Some toothpastes and fluorides, or touching a certain part of the oral cavity (such as the back of the tongue or palate) can cause a person to gag and vomit. Brushing with only water may be the best treatment.
Some distraction methods to consider:
- Asking the person to wiggle their foot
- Tap their hand on their leg
- Breathe through their nose
- Put salt on the tongue
Tardive Dyskinesia
Tardive dyskinesia is an oral movement disorder and may occur in persons taking antipsychotic medications for a long period of time, even after the medication has been stopped.
Involuntary movements may make it more difficult to perform oral hygiene. Using bended toothbrushes to hold tongue and cheeks when brushing with another brush may help.
Oxygen Use
Constant oxygen use may cause dry mouth.
Consider the following:
- Using saliva substitutes in the mouth
- Use lanolin on the lips
- Use soft toothbrush
- Gentleness when preforming oral hygiene
- Tissues are more delicate
Unconsciousness
When providing care to an unconscious person:
- Turn them on their side
- Put a towel under the cheek
- If needed, place a basin under the chin and cheek to catch excess moisture
Dampen a single use mouth swab or toothbrush with artificial saliva/water/alcohol-free mouth rinse, gently apply to teeth, gums, tongue, and inside surfaces of mouth. This will moisten the lips and mucous membranes prior to providing oral care to help prevent added trauma to oral cavity.
Bed Ridden
Support the person as needed while maintaining respect and encouraging independence.
If assistance is required, elevate the person’s head in bed or in a wheelchair.
Consider the following:
- Person’s ability for rinsing, spitting, swallowing, etc.
- Need for toothpaste vs. rinses
- The need for a suction brush
Seizures
Convulsions occur when a person’s body shakes rapidly and uncontrollably and can result in chipped or broken teeth.
Causes include:
- Epilepsy
- stroke
- head trauma
- brain tumor
Common medications for seizures can cause overgrown gums, bleeding gums, and dry mouth. Irritated gums increase the risk for oral infections and sores.
Rheumatoid Arthritis
This condition may make it difficult to handle a toothbrush.
Many adaptations are available:
- Having a bicycle grip on toothbrush handle-filled with plaster to make it solid
- Insert brush in rubber ball or Styrofoam ball
- Put brush in roll of foam rubber
- Secure nail scrub brush handle to the toothbrush handle (remove bristles of scrub brush)
- Attach a Velcro strap to brush handle
Person is Agitated
- Assess the risk of self-injury or hurting others.
- Assess feasibility of performing oral care at the time.
- Use Rescuing and/or Distraction
- Reassure and help the person relax
Person is Asleep or Tired
- Assess if the person is sleepy or if another condition is causing the sleepiness
- Try a different time of day
Boredom
Person may be tired of doing the same thing every day
- Try new products, flavors, colors
- Try music or any favorite activity
- Make it fun and be creative
- Asking the person what could be done to reduce boredom
Dysphagia
Dysphagia is difficulty swallowing. It may be necessary to use water or an anti-bacterial mouth rinse on the brush instead of toothpaste.
Dysphagia Continued…
If a person has dysphagia it is important to clean excess food and debris from the person’s mouth to prevent aspiration.
Utilize swab, gauze wrapped fingers, or suction toothbrushes (which aspirates saliva and toothpaste foam as it brushes).
Pocketing of Food
As people age, and if a person has had a stroke, food does not always clear the tongue. This causes pockets of food to collect inside cheeks.
Consider this:
- Excess food needs to be cleaned before brushing
- Use a single use mouth swab or gloved finger
- This must be done before bed
Cannot Remove or Replace Dentures –Lower
- Ask the person to remove/replace their dentures
- Use opening mouth techniques seen in: Will Not Open Mouth
- For the lower denture, pull up gently while applying a rocking motion
- Avoid placing your fingers between biting surfaces of teeth
- Insert denture at an angle
