Oral Hygiene Care in Critically Ill Patients‪.‬

Mosby's Dictionary defines oral hygiene as 'the condition or practice of maintaining the tissues and structures of the mouth. Oral hygiene includes brushing the tongue and teeth to remove food particles and residue, bacteria, and plaque; massaging the gums with a toothbrush, dental floss, or water irrigator to stimulate circulation and remove foreign matter; and cleansing dentures and ensuring their proper fit to prevent irritation. Dependent or unconscious patients are assisted in maintaining a healthy oral condition. Such care includes lubricating the lips and cleaning the inside of the cheeks, the roof of the mouth, and the tongue.' (1) Oral care is a fundamental aspect of nursing that impacts on the health, well-being and comfort of patients. (2) Providing effective oral hygiene for patients in critical care units is particularly challenging as the patient's oral health may be compromised by medical conditions, treatment interventions, equipment, and the patient's inability to attend to his or her own oral care. The presence of an orogastric tube, endotracheal tube and other items necessary for the monitoring and management of a critically ill patient complicates the procedure. Some caregivers may even consider inserting the tools of oral care into a patient's mouth an invasion of the patient's privacy. (3) Oral hygiene care practices for a critically ill patient include assessment of the oral cavity, brushing the teeth, moisturising the lips and mouth and suctioning the mouth and oropharynx. (4-6) Related care practices are repositioning and securing of the endotracheal tube, tracheostomy care and endotracheal suctioning. (6)