Curiosity, Dialogue, and Knowledge
With a patient that has been made NPO, no food/drink by mouth, the importance of strict oral care can’t be emphasized enough when providing patient’s and families education. There are several studies that provide ample ammunition for this laser focus on oral care with a new stroke patient, especially one that has recently been made NPO. (I give references and talk about this in more detail on the post Quality vs Quantity (or is it safety?)).
While I have often used the “sponge on a stick” type medical equipment when performing oral care, the best item to use in most situations is the good old-fashioned toothbrush. This actually makes a lot of intuitive sense, but we often are hesitant to use a toothbrush with a patient that is NPO because we are afraid they may swallow the toothpaste or the water “down the wrong pipe”. We should either use a wet toothbrush without toothpaste or one with a very small amount with our high risk patients.
Without vigilant observation and intervention, our NPO patients will get thrush. (Check out Mayo Clinic’s definition and picture of thrush here) Thrush is bad. Besides being painful, thrush can have serious medical implications for our patients. Xerostomia (dry mouth) can lead to thrush and is caused primarily by medications, but can also be caused by radiation therapy if the salivary glands are compromised or by Sjogren’s syndrome, a disorder that attacks the salivary glands among other things. Cavities are also a big problem for our patients. A study by Susan Langmore notes that a patient’s number of cavities was a leading risk factor for developing aspiration pneumonia in adults receiving medical care.
If you feel confident that the patient is cognitively intact enough to do it, then using alcohol free rinse can be a good adjunct to tooth-brushing. It’s important to use alcohol free rinse, because alcohol dry’s out the mouth. I don’t usually recommend one brand over another, but just make sure you keep away from the alcohol!
The truth is that different research about this (with respect to the medical field) gives different numbers. Some say as little as twice a day, and others recommend every 2-4 hours. There will obviously be some patient specific barriers and modifying factors, but my general advice to patients and families is to shoot for 3-4 times a day. As to the general how-to aspect, the picture from The Children’s Oral Health Institute does a good job of breaking it down in English or Spanish (see below).