A Mouth Care Clinical Practice Guideline - Essay Example

TO DEVELOP A MOUTH CARE CLINICAL PRACTICE GUIDELINE September 04, 2008 Effective mouth care practice is a crucial hustle and bustle of our daily lives meant to prevent the future complications, therefore critical analysis of the philosophy, knowledge and theory relevant to mouth care practice is becomes of utmost importance. According to Daniel Perry "The mouth and face can be likened to a crystal ball, predicting diseases and conditions yet to come” (Wolfe E,2003 : 1). To combat the threat which is prominent due to improper mouth care or oral problems, nursing practice plays a vital role, where they need to face number of challenges to apply the knowledge to actual practice; therefore the sensible and prudent use of the theory and the necessary skills is essential to provide high quality and effective mouth care practice (Wilkin K, 2002 :1). Poor oral health could be linked with malnutrition, dehydration, pneumonia, joint infections and many other problems. The objective of our study revolves around developing an effectual and valuable mouth care clinical practice guideline. Considerable evidence from the past researches reveals the fact that there exists an alarming relationship between poor oral health and numerous resultant diseases causing oral micro flora or the bacterial pneumonia, as well as other illness. In such acute conditions the role of nurses in spreading awareness and importance of mouth care, becomes imperative. Mouth care is an essential nursing course of action that nurses are expected to have good knowledge of, in absence of such knowledge the quality of patient care is certainly detrimental and results in unsafe clinical practice. Health professionals should be trained in such a manner that oral screenings becomes a part of their routine physical examination. (Jennifer L. Cohn, 2006 :1) Maintaining oral hygiene is important at every stage of our lives, right from our infant stage to our second childhood which is the old age, but for ageing seniors and young children, dental care becomes a greater matter of concern. The mouth is a representative of multiple stressors and when one ages, the capacity of the mouth to tolerate the different kind of stress reduces. With an increase in the bodily complications and medication usage, the prevalence of root caries, tooth loss etc increases eminently. However life-long exposure to fluoride has resulted in reduced tooth loss and lower caries rates. Old people over 60 loose almost all their teeth. Diseases affecting the mouth and the throat are very common and it is mainly cavities and cancer that take the lead. Children between the ages of 12-15 are the main sufferers of cavity. Mouth and throat cancers are yet another very common disease soaring up at a very rapid pace among the people who are addicted towards alcohol or smoker more prominent in mid age groups and the aged. People suffering from chronic illness such as cancer, tuberculosis or even diabeties are often found with signs of dental problems. Oral problems reflect the general health of the patient and therefore complications arising from such adverse situations become increasingly common with advancing illness. Oral problems are common, and often predictable in few illnesses such as cancer following chemotherapy and head and neck radiotherapy. According to the Clinical Knowledge Summaries, 2004: 10, 90% cancer patients reported signs of dry mouth. Approximately 40% of Chemotherapy patients develop an oral problem related to treatment; almost all patients who receive radiotherapy to the head or neck develop oral mucositis. As adults face the progressing age, simple tasks such as brushing or flossing become difficult due to physical and cognitive bodily changes. Clinical guidance which can be imparted to the old age people, to prevent the complications that result from poor mouth care include use of electric toothbrush or toothbrushes with larger handles for easier gripping with regular oral rinses or mouthwash. A simple rinse with water or a salt solution, using one teaspoon of salt in one quart of water is an effective solution for proper mouth care. A healthy adult can produce approximately 1-5 liters of saliva a day which helps to protect his mouth, teeth and gums in a natural manner but age diminishes the production of saliva due to absence of healthy diet and other medical problems due to which a person who is unwell is at risk of dry mouth, soreness, candidiasis (fungal infection), altered taste and halitosis (bad breath). Sick and old people are much more prone to oral infections such as Thrush. The problem faced by the patient is that he cannot swallow properly and the tiny particles which remain left in the mouth augments infections. The elderly people are neglected and receive inadequate oral health care, increasing the chances of getting trapped to more serious diseases. (Gavin G. Lavery, Brian V. McCloskey, 2008 : 1) Complications resulting from poor mouth care are very common. Few problems which are observed in most of the cases are Bad Breath, Dental Strains, Gum Diseases, and Tooth Sensitivity etc. Tooth decay due to dental caries, bleeding gums (gingivitis), loose teeth due to periodontal bone loss, Bad breath because of oral malodor are problems that lead to severe problems later. 70 percent of the people experience periodontal diseases bad breath, colored or stained teeth is a common indicator of poor oral care, bleeding gums, tooth sensitivity to hot and cold food intake is also very prominent (Genco R, Offenbacher S, Beck J, 2002 : 2). Plague is a common problem caused by gum disease and tooth decay. It is a layer of bacteria formed when the mouth comes in contact with the sugar and starches that in turn cause infection. Many patients suffer from the problem of tooth decay which can create tooth cavities and weaken the other surrounding nerves as well. According to the U.S researchers, germs found in dental plaque can even affect the lungs and cause pneumonia in elderly nursing home patients .The research conducted revealed that out of 49 patients, 28 had germs known to cause respiratory disease in their dental plaque samples ,out of which 14 patients eventually developed pneumonia and rest showed signs of respiratory disease. According to Barbara Resnick, Mouth is a place which is often overlooked by the old people and the people taking care of them. Proper care could help in prevention of serious health ailments caused by poor oral hygiene, such as gingivitis and pneumonia (American Geriatrics Society, Viewed on 24th August, 2004: 1). Disfigurement, trismus and oro-cutaneous fistulae are problems observed in patients suffering from oral cancers (Sister Casilda, Krishnaswamy M, 2005:2). Common complications of ulcers and sores that do not heal, a prolonged painful or the numb part of the mouth, presence of black spots or patched areas are often seen among regular smokers who neglect oral hygiene. Evidences state the presence of poor oral health linked to coronary heart disease (Laurie Barclay, 2004:1) Most of us our aware about sore gums, statistics reveal that 19 out of 20 people suffer from gum problems during their life. If proper care is not taken gum infection can lead to painful abscesses and tooth loss. If the gums bleed, then the chances of gingivitis are higher, reason they are inflamed is due to a bacterial infection which has overcome the natural defense mechanisms of the body. A health care provider or the nurses should offer suggestion and proper advice to people with specific needs like adults using dentures should take proper care of them by cleaning them after each meal and soaking them overnight (American Geriatrics Society, viewed on 24th August, 2004). A clinical guide must include the common instructions which should be explained to the patients in general for maintaining better oral care , for instance, Saliva is the nature’s way of preventing tooth decay which many of the people are unaware about, negative affects of caffeine, medications, air conditioning, dehydration should be clearly explained in the guide. There are many organizations who are actively working to spread a word in shaping attitudes, policies, and practices in geriatric medicine and oral clinical practice to medical professionals. For instance American Geriatrics Society is an organization dedicated to improving the health and quality of life by emphasizing on oral mouth care. Instruction such as thoroughly brushing and flossing every day must be communicated well. The regular cleaning of the teeth ensures that the plaque build-up as per individual’s body is sustained at body’s coping level. A proper diet chart should be framed for people who are more prone to mouth problems, especially our current generation which exhibits a complete change in eating habits such as intake of junk food, improper meals, sugared drinks etc. Importance and essence of eating fresh fruits, vegetables and whole grain (wheat) breads, Limiting sugars and starches, drinking or rinsing mouth with water often and after meals or snack foods, brushing at least twice a day or more often if mouth problems are severe, need to be openly talked about . A good oral health regime will generally fix aliments of mouth but if the condition persists, dentist’s intervention becomes essential. Poor dental health does not affect the dental stature but also strikes at a person’s comfort, appearance, eating, nutrition, behaviour and general health. Clinical practices must incorporate extensive information about the use of oral care solutions, provision of an oral care guide must include general awareness about routine mouth examination administered every 2- 4 weeks and proper care could certainly reduce the risk of oral problems. Use of pink swabs or gloved finger, effective toothpaste, clean toothbrush, clean dentures etc all must be a part of the clinical guide with supportive equipments and tools, imparting family education pertinent to oral care of their patients and Offering in-service education on oral hygiene in order to update nurses and combat knowledge deficits is also an effective clinical practice measures. There is more to a mouth than just teeth and gums. Oral Health means more than just an attractive smile. Poor oral health and untreated oral diseases have a negative impact on the quality of life a person leads. Dental practice needs to focus on methods for conducting dental treatments in a manner which is not stressful or increasing the anxiety level of already suffering person. Best results can be accomplishes by educating and communicating the individual person to determine the best possible course of action to prevent or cure the oral problem. A dentist’s intervention can provide solutions to irritating mouth practices as well alarming signs to save oneself from the future problems (Staff Reports, 2007:1) There are many elements and components of effective dental care. No matter what method is applied for the treatment, an integral role needs to be maintained both by the medical practitioners and the each individual himself. The diseases that affect the mouth may sound deadly and fearsome but it's never too late to take care of our most precious smile, just a little thought, care and awareness in needed. The alarming signals of poor oral care is reflected in the report by the Surgeon General's on oral health in America where a major chunk of population suffers from a reduced quality of life due to oral and facial pain.( Morbidity & Mortality Weekly Report, 2000) . According to the research more than 75 percent of the population is affected by some type of periodontal disease or gingivitis which itself is a great number to judge the presence of the common oral problems prevalent in current times. A clean mouth contains several hundred billion bacteria, and one can imagine the number of bacteria a not sufficiently mouth contains. A clinical practice includes reflection and analyses of the lifestyle parameters which play a imperative role in promoting oral health, encouraging exercising, walking and discouraging smoking, stress, depression (Wood N, 2004). Mouth care is an area in the medical field that seems to have low priority however oral care is a very important nursing activity which helps in aiding comfort and chalking out a preventive action plan against infection and maintaining the patient’s nutritional status. The complexity of mouth care for any patient is adjudicated by the medical or the surgical as well as the psychological effects of mouth care. The oral clinical practice also includes a philosophical approach to mouth care which requires the nurses to of view the practice from different perspectives, not only from medical point of view but also from social and economic aspects. BIBLIOGRAPHY 1. Sister Casilda, Krishnaswamy M, 2005, Wound Care in Resource Poor Settings, Volume: 11, Issue: 2, Page: 105 107, Viewed on 24th August, 2008, http://www.jpalliativecare.com/article.asp?issn=09731075;year=2005;volume=11;issue=2;spage=105;epage=107;aulast=Casilda 2. Gavin G. Lavery, Brian V. McCloskey, The Difficult Airway in Adult Critical Care, Crit Care Med. 8th Dec,  2008; 36(7):2163-2173, http://www.medscape.com/viewarticle/578622 3. Jennifer L. Cohn, 24th Mar, 2006, Nursing Staff Perspectives on Oral Care for Neuroscience Patients, J Neurosci Nurs.  2006;38(1):22-30, http://www.medscape.com/viewarticle/527868s 4. Laurie Barclay, Feb. 16, 2004 Poor Oral Health Linked to Coronary Heart Disease, http://www.medscape.com/viewarticle/469444 5. Morbidity & Mortality Weekly Report, Notice to Readers: Publication of Surgeon General's Report on Oral Health, MMWR 49(25), 2000, http://www.medscape.com/viewarticle/413989 6. Genco R, Offenbacher S, Beck J. Periodontal disease and cardiovascular disease: epidemiology and possible mechanisms. J Am Dent Assoc. Jun 2002; 133 Suppl: 14S-22S.  7. Wood N, Nov 2004, How Poor Oral Health Promotes Systemic Diseases, Viewed on 24th August, 2008, http://www.lef.org/magazine/mag2004/nov2004_report_oral_01.htm 8. 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Staff Reports, 3rd September, 2007, Family health: Path to good health runs right through your mouth, Viewed on 24th August, 2008, http://www.commercialappeal.com/news/2007/sep/03/a3hm/?printer=1/ 12. Elizabeth Wolfe, September 22, 2003 , Dental Care for Elderly Lacking, The Associated Press/The Washington Post, http://www.stress\Dental Care for Elderly Lacking.html Read More