| Skill 7-5 | Providing Denture Care | ||||||||||||||||||||||||||||||||
Adequate oral hygiene care is imperative to promote the patient's sense of well-being and comfort, and prevent deterioration of the oral cavity (Kisely, 2016; Riley, 2018). Poor oral hygiene contributes to the colonization of the oropharyngeal secretions by respiratory pathogens. Plaque, which can accumulate on dentures, can promote oropharyngeal colonization of pathogens (American Dental Association [ADA], 2021). Diligent oral hygiene care can improve oral health and limit the growth of pathogens in the oropharyngeal secretions, decreasing the incidence of aspiration pneumonia, community-acquired pneumonia, nonventilator health care-associated pneumonia (NV-HAP), and ventilator-associated pneumonia (VAP) (AACN, 2017; Chick & Wynne, 2020; Jenson et al., 2018; Quinn et al., 2020). Comprehensive oral care that includes thorough mechanical cleaning is an important part of care to achieve oral health outcomes for patients in all settings (Barbe et al., 2020; Chick & Wynne, 2020; Chicote, 2019; Gibney et al., 2019; Kisey, 2016). It is important to clean dentures daily and to remove and rinse dentures and mouth after meals. Dentures may be cleaned more often, based on need and the patient's personal preference. To reduce or minimize denture stomatitis (irritation of the oral tissues), it is recommended that dentures not be worn continuously (24 hours per day); dentures are often removed at night (American College of Prosthodontists [ACP], n.d.). Handle dentures with care to prevent breakage. Refer to Box 7-2 in Skill 7-3 for suggestions to meet the oral hygiene needs for patients with cognitive impairments. Delegation Considerations The implementation of denture care may be delegated to assistive personnel (AP) as well as to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A. Assessment Assess the patient's oral hygiene preferences: frequency, time of day, and type of hygiene products. Assess for any physical activity limitations. Assess for difficulty chewing, pain, tenderness, and discomfort. Assess the patient's gag reflex. Decreased or absent gag reflex increases the risk for aspiration. An oral assessment tool can assist with assessment of the status of the oral cavity as well as help to determine the frequency and procedure for oral care (Figure 1 in Skill 7-3). Assess the patient's oral cavity. Look for inflammation, edema, lesions, bleeding, or yellow/white patches. The patches may indicate a fungal infection called thrush. Assess for signs of dehydration (dry mucosa). Look at the lips for dryness or cracking. Assess the patient's ability to perform their own care. Actual or Potential Health Problems and Needs Many actual or potential health problems or issues may require the use of this skill as part of related interventions. An appropriate health problem or issue may include: Outcome Identification and Planning The expected outcome to achieve is that the patient's mouth and dentures will be clean, the patient will exhibit a positive body image, and the patient will verbalize the importance of oral and denture care and demonstrate appropriate oral and denture care skills. Implementation
Evaluation The expected outcomes have been met when the patient's oral cavity and dentures have been cleaned and are free from complications, and the patient has verbalized or demonstrated improved body image. In addition, the patient has verbalized a basic understanding of the need for oral care and has demonstrated appropriate oral and denture care skills. Documentation DevelopingClinical Reasoning and Clinical Judgment Special Considerations
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1. Perform hand hygiene and put on PPE, if indicated.
2. Identify the patient. Explain the procedure to the patient.