[Dysphagia] Toothettes

[eripley at yahoo.com (Irene Campbell-Taylor)]

The subject of toothettes and mouthwashes etc. came up again. Nursing - at least the RN group- does not advise the use of toothettes. See the following:
   
  ORAL CARE INTERVENTIONS IN CRITICAL CARE:
  FREQUENCY AND DOCUMENTATION
  By Mary Jo Grap, RN, PhD, ACNP, Cindy L. Munro, RN, PhD, ANP, Brooke Ashtiani, and Sandra Bryant. From
  Virginia Commonwealth University School of Nursing, Richmond, Va.
  ? BACKGROUND No data have been collected to describe the products, methods, and frequency of oral are needed to reduce dental plaque, oral colonization, and ventilator-associated pneumonia in critically ill patients.
  ? OBJECTIVES To describe the frequency of use of oral care interventions reported by nurses in several intensive care units in a large southeastern medical center.
  ? METHODS Staff members completed a written survey describing their oral care practices, and oral care interventions were recorded from the unit?s flow sheet for the previous 24 hours for all patients at 5 randomly selected times during 1 month.
  ? RESULTS Most respondents (75%) reported providing oral care 2 or 3 times daily for nonintubated patients, and 72% reported providing care 5 times daily or more for intubated patients. However, oral care was documented on the unit?s flow sheet a mean of 1.2 times per patient. Reported use of toothpaste and a toothbrush was significantly greater in nonintubated patients (P < .001), and use of a sponge toothette was significantly greater in intubated patients (P < .001). Nurses? mean rating of oral care
  priority was 53.9 on a 100-point scale.
  ? CONCLUSIONS Despite evidence that they are ineffective for plaque removal, sponge toothettes remain the primary tool for oral care, especially in intubated patients in intensive care units. Nurses report frequent oral care interventions, but few are documented. Education and focus on good oral care strategies are required; nursing research to delineate the best procedure for all patients in intensive care
  units is needed. (American Journal of Critical Care. 2003;12:113-119)
   
  http://jada.ada.org/cgi/reprint/137/suppl_2/21S
   
  http://ajcc.aacnjournals.org/cgi/reprint/12/2/113?ijkey=5173f1f1e4425dda6578abc471b5a5ac916eb2b0
  
Assessment of nurse-administered oral hygiene. 
  Nurs Times. 1995 Mar 1-7;91(9):40-1.

Moore J.

It has been suggested that nurse educators and the establishments in which they are employed should review their basic training criteria for nurse-administered oral hygiene. This literature review illustrates that there has been little, if any, change in oral hygiene practices over the past 29 years and much of the research still in existence is now outdated. The majority of papers reviewed highlight a frightening scarcity of research data available within this field. The author concludes that standards should be set regarding routine mouth-care practices and calls for an accurate rating scale to be devised on which care can be accurately planned, implemented and evaluated.
   
  
A comparison of the ability of foam swabs and toothbrushes to remove dental plaque: implications for nursing practice.
J Adv Nurs. 1996 Jan;23(1):62-9.
Pearson LS.

Institute of Nursing Studies, University of Hull, England.

This study aimed to assess the impact which the use of a toothbrush and the use of foam swabs had on the removal of dental plaque over a 6-day period. Three experiments were completed and duplicated using the author's mouth and one of these experiments was completed a third time on a volunteer's mouth. A plaque scoring system which quantified the amount of plaque on teeth in areas adjacent to periodontal tissue, and therefore capable of initiating inflammation, was used after plaque had been disclosed. Plaque at the gum/tooth margin (gingival crevice plaque) and plaque between teeth (approximal plaque) was measured. At the end of each 6-day period, which commenced with all tooth surfaces clean, the ability of the toothbrush to remove plaque was consistently better than that of swabs, and usually achieved complete visible plaque removal from all sites. In contrast, plaque remained in all sites which had been cleaned using foam swabs (after using a 'swabbing' or 'scrubbing'
 technique). However, it was possible to remove plaque from a number of gingival crevice sites with a swab when a varied 'any technique' was used on the visible disclosed plaque. The plaque in all approximal sites still remained after this technique. An experiment to measure the effect of using foam swabs on plaque which had been allowed to accumulate over a 6 day period produced similar results. The results from this study suggest that the success of a toothbrush in removing plaque is affected by user technique (total visible plaque removal was not achievable), and that foam swabs are not able to remove plaque from some 'sheltered' areas of teeth (total visible plaque removal was not achievable). The implications of these findings to nursing practice are discussed.
   
  
Qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards.
   
   J Adv Nurs. 1996 Sep;24(3):552-60.

Adams R.

Derriford Hospital, Plymouth, England.

This study tested the theoretical proposition that qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards. The research was undertaken in a local district general hospital during January 1995. The project aimed to look at local practices of qualified nurses related to oral care of patients hospitalized in medical wards. Extent of knowledge and current practice of care was examined using a questionnaire. Open and closed style questions were used. The sample comprised nurses on one elderly care ward and three general medical wards and the sample size was 34. The results revealed gaps in knowledge of oral care procedures. In particular, a lack of assessment and documentation was highlighted. However, the nurses indicated a high level of interest at updating themselves in this area of nursing. The limitations of this study are discussed.
   
             [input] 1: Crit Care Med. 1998 Feb;26(2):301-8.
    Related Articles,           Links

  
Comment in: 
  ?         Crit Care Med. 1999 Jan;27(1):225-6. 
  
Colonization of dental plaque: a source of nosocomial infections in intensive care unit patients.

Fourrier F, Duvivier B, Boutigny H, Roussel-Delvallez M, Chopin C.

Service de R?animation Polyvalente, H?pital Roger Salengro, Lille, France.

OBJECTIVE: To study the dental status and colonization of dental plaque by aerobic pathogens and their relation with nosocomial infections in intensive care unit (ICU) patients. DESIGN: A prospective study in a medical ICU of a university-affiliated hospital. PATIENTS: Consecutive patients admitted to the ICU during a 3-mo period. INTERVENTIONS: Dental status was assessed by the same investigator using a score adapted from the "Caries-Absent-Occluded" (CAO) index (referred to in the U.S. as DMFT [Decayed-Missing-Filled Teeth] index). The amount of dental plaque on premolars was assessed using a semiquantitative score. Quantitative cultures of dental plaque, nasal secretions, tracheal aspirates, and urine were done at admission (day 0) and every fifth day until death or discharge. An additional study was done in eight patients to serially compare dental plaque, salivary, and tracheal aspirate cultures during a 2-wk period. MEASUREMENTS AND MAIN RESULTS: Fifty-seven patients
 were included in the main study. Due to the variability in their ICU stay, 29 patients could be examined on day 0 only (group A), 15 patients on days 0 and 5 (group B), and 13 patients on days 0, 5, and 10 (group C). The mean dental CAO score was 16 +/- 8 and did not change during the ICU stay. The dental plaque score was < or =1 in 70% of patients on day 0; > or =2 in 50% of patients on day 5; and > or =2 in 90% of patients on day 10. Dental plaque cultures were positive at 10(3) colony-forming units/mL for aerobic pathogens in 23% of patients on day 0; 39% of patients on day 5; and 46% of patients on day 10. In groups B and C, mean dental plaque score and frequency of plaque colonization increased from days 0 to 5 and from days 5 to 10. A high bacterial concordance was found between dental plaque and tracheal aspirate cultures, and in the additional study, between salivary and dental plaque cultures. Twenty-one patients developed a nosocomial infection in the ICU. Dental
 plaque colonization on days 0 and 5 was significantly associated with the occurrence of nosocomial pneumonia and bacteremia (sensitivity 0.77; specificity 0.96; positive predictive value 0.87; negative predictive value 0.91; relative risk 9.6). In six cases of nosocomial infection, the pathogen isolated from dental plaque was the first identified source of nosocomial infection. CONCLUSIONS: The amount of dental plaque increased during the ICU stay. Colonization of dental plaque was either present on admission or acquired in 40% of patients. A positive dental plaque culture was significantly associated with subsequent nosocomial infections. Dental plaque colonization by aerobic pathogens might be a specific source of nosocomial infection in ICU patients.
   
   
   


Dr I Campbell-Taylor
Clinical Neuroscientist
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