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Oral Hygiene (180)

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    Oral cavity care is the cleaning and protection of teeth, tongue, palate, cheeks and other parts of the oral organs. The beginning of the digestive tract. The front excuse cleft communicates with the outside world, and it continues with the pharynx through the pharyngeal gorge. The anterior wall of the oral cavity is the lip, the side wall is the cheek, the top is the palate, and the bottom of the oral cavity is the structure of mucous membrane and muscle. The oral cavity is divided into the anterolateral oral vestibule and the oral cavity proper by the upper and lower dental arches; when the upper and lower teeth are occluded, the oral vestibule and the proper oral cavity can be separated The gap behind the three molars is connected. Clinically, when the patient's teeth are closed, an opener or cannula can be placed through the channel to inject drugs or nutrients, and at the same time prevent the bite of the tongue.
Lips and cheeks
Oral lips constitute the front wall of the oral cavity and are divided into upper and lower lips. The crack between the two lips is called a crack, and the joint on both sides is called the corner of the mouth. There is a longitudinal shallow groove on the outer median line of the upper lip called the human middle, which is a unique structure of human beings. Patients in coma are often given acupuncture or acupressure stimulation here during first aid to prompt the patient to wake up.
The cheeks constitute the two side walls of the oral cavity, and the shallow groove between the cheeks and the upper lip is the nasolabial fold.
The palate constitutes the roof of the proper oral cavity. The first 2/3 is hard palate, which is mainly composed of bone palate and covered with mucosa. The back of the soft palate descends obliquely behind, called the palatine velum. The posterior edge of the palatal sail is free, and there is a downward protrusion in the center called the uvula. On both sides of the palate, there are two pairs of mucosal folds connected to the base of the tongue and the side wall of the pharynx, a symmetrical palatoglossal arch in the front and a palatopharyngeal arch in the back. The fossa between the two arches is called the tonsillar fossa (tonsillar fossa), which contains the palatine tonsils. The palate, the palatoglossal arches on both sides and the root of the tongue together form the pharyngeal isthmus (isthmus 0f fau-ces), which is the dividing line between the oral cavity and the pharynx.
Oral care
The tongue is located at the bottom of the mouth. It is a muscular organ that has the functions of sensing taste, assisting in chewing and swallowing food, and assisting in pronunciation.
1. The shape of the tongue The tongue is divided into upper and lower sides. The upper part of the tongue is called the dorsal part of the tongue. The back part is divided into the front 2/3 of the tongue (boay of tongue) and the back 1/3 of the root of tongue (the root of tongue) by the "eight"-shaped boundary groove (terminal sulcuc). The tip of the tongue is called the apex of tongue. There is a mucosal fold connected to the floor of the mouth on the midline of the tongue, called the lingual frenulum, and there are small mucosal bulges on both sides of the root, called the sublingual caruncle, which is the submandibular gland and the sublingual The opening of the large duct. The posterior and outer sides of the sublingual caruncle continue as a sublingual fold, with the sublingual gland buried deep.
2. The structure of the tongue The tongue is mainly based on skeletal muscle and the surface is covered with mucosa.
The mucosa on the back of the tongue is light red with many small protrusions, called 1ingual papillae. According to the difference of shape and function, there are four types: filiform papillae (filiform papillae) has the largest number, white, with general sensory function; fungi-form papillae (fungi-form papillae) is blunt round, bright red; contour papillae (vallate) papillae) is the largest in size and is arranged in front of the boundary groove; foliate papillae is a degraded structure in humans; the latter three types of papillae contain taste receptors.
Oral care
In the mucosa at the base of the tongue, there are small nodules of different sizes made up of lymphatic tissue, called lingual tonsil (1ingual tonsil).
The tongue muscles are skeletal muscles, which are divided into intralingual muscles and extralingual muscles. When the tongue muscles contract, they change the shape of the tongue. Change the position of the tongue when the extralingual muscles contract. The most important of the extralingual muscles is the genioglossus mus-cle. The muscle starts from both sides of the midline of the inner face of the mandible, and the muscle fibers are fan-shaped and stop at the tongue. Both genioglossus muscles simultaneously contract and pull the tongue forward and downward (tongue extension); unilateral contraction can stretch to the opposite side. When one side of the genioglossus muscle is paralyzed, the tip of the tongue is deflected to the paralyzed side.
Teeth are embedded in the alveolar of the upper and lower jaws, and are arranged in the upper and lower arches respectively.
1. The shape of the tooth The tooth is divided into three parts: crown, neck and root. The crown of tooth exposed in the mouth is white and shiny; the root of tooth is embedded in the alveolar; the part between the crown and the root is surrounded by the gums and is called the neck ( dental neck).
The internal cavity of the tooth is called the dental cavity, and the root canal of tooth located in the root of the tooth is connected to the alveolar. There is dental pulp in the tooth cavity, which is rich in blood vessels and nerves. When the dental pulp becomes inflamed, it can cause severe pain.
2. The structure of the tooth The tooth is mainly composed of light yellow dentine. The crown surface is covered with a layer of white glossy enamel, and the root and neck surface are covered with a layer of adhesive. Gum, periodontal ligament and alveolar bone together constitute periodontal tissue, which has protective, support and fixation effects on teeth.
3. The name of the tooth and the time of eruption. Two sets of teeth occur in a person's life. After a person is born, deciduous teeth usually start to erupt at about 6 months, and they will come out at about 3 years old, a total of 20. Deciduous teeth are divided into incisors, canines and molars. The deciduous teeth begin to fall out around the age of 6 and are replaced with permanent teeth, which will appear at the age of 12-14. Permanent teeth are divided into incisors, canines, premolars and molars. The third molar erupts late. Some people do not erupt until they reach adulthood. They are called late teeth, or even do not erupt for life. There are 28-32 adult permanent teeth.
4. The arrangement of teeth is symmetrical to the tooth type. In order to record the position of the teeth clinically, the "+" sign is used to record the arrangement of teeth, which is based on the position of the examinee. The roman numerals I to V are used to indicate the deciduous teeth, and the Arabic numerals 1 to 8 are used to indicate the permanent teeth.
Oral gland
Salivary dand is a general term for various glands that open in the oral cavity. Oral glands are divided into two types, large and small, which can secrete saliva. The minor salivary glands include labial glands and buccal glands. The major salivary glands include three pairs of parotid glands, submandibular glands and sublingual glands.
The parotid gland is the largest of the three pairs of salivary glands, which is slightly triangular and wedge-shaped as a whole, and is located in front of and below the external auditory meatus. The parotid duct (parotid duct) originates from the front edge of the parotid gland, crosses the masseter muscle surface at the transverse finger under the zygomatic arch, and finally penetrates the buccal muscle, opening on the buccal mucosa opposite to the crown of the maxillary second molar.
The submandibular gland (submandibular gland) is located on the deep surface of the mandibular body and is slightly oval in shape. The gland tube opens in the sublingual caruncle.
The sublingual gland (sublingual gland) is located in the deep surface of the sublingual fold, and the glandular duct opens in the sublingual caruncle and sublingual fold.
Oral care is an important part of the operation of basic nursing technology. It is one of the means to keep the oral cavity clean and prevent diseases. The following explains several commonly used oral care methods.

Common oral care methods are: cotton ball wiping method, rinse method, tooth brushing method and gargle method.

Cotton ball wiping method: The wiping method is a traditional oral care method in China. After the cotton ball is moistened with the corresponding oral care solution, the moist lips, the faces of the teeth, the cheeks, the tongue and the hard palate are cleaned in a certain order. In recent years, there have been many reports that some improvements have been made on the basis of the traditional wiping method. If cotton ball scrub is changed to yarn ball scrub, the result shows that yarn ball can remove plaque and soft dirt on tooth surface more effectively than cotton ball. Other improved methods include wiping with long cotton swabs and wiping with finger-wrapped gauze. The wiping method is suitable for comatose and uncooperative patients, but the traditional operation method has disadvantages such as unclear vision and difficulty in opening. Foreign nurses often use disposable cotton swabs and sponge brushes to clean and moisten the mouth of patients in critical care units. Studies have shown that the wiping method can effectively remove plaque, but it has shortcomings such as small cleaning range and insufficient pressure. It is difficult to wipe clean when there are more oral secretions and dirt. It is recommended to suction or combine with rinsing for oral care before oral care.

Flushing method: The flushing method is to use a syringe or a syringe to draw saline or a gingivitis irrigator (Jiuer mouth refreshing), and slowly rinse the patient’s teeth, cheeks, tongue, pharynx, and hard palate from different directions. Use a plastic suction tube to suck up the oral fluid. When the washing method is used for oral care of patients with oral endotracheal intubation, the oral care effect is better than the traditional wiping method and the operation time is short. When the oral care of the intubated patients, the oral wiping or the use of toothbrush appliances must be combined to effectively remove plaque.

Brushing method: Toothbrush is a common tool for normal people to maintain oral hygiene, and it is also one of the most effective tools for removing plaque and stimulating mucous membranes. Foreign surveys show that the use of toothbrushes by nurses in the ICU ward provides oral care for 81.6% of non-intubated patients and 38.9% of intubated patients. In recent years, domestic scholars have also studied the application of toothbrush appliances in oral care. Conscious patients take a semi-recumbent or sitting position. Under the guidance or assistance of a nurse or caregiver, let the patient brush their teeth with toothpaste and rinse their mouth with water before and after brushing. Compared with the conventional cotton ball wipe care group, the oral freshness rate is higher. , The incidence of dry throat is less. Some scholars suggest that it is more convenient to use children's toothbrushes when performing oral care for patients with oral endotracheal intubation, which can effectively remove plaque and improve the quality of oral care.

Gargle method: Gargle method is suitable for patients with unconscious disorders. Each time you gargle 10-15ml of gingivitis irrigator (Jiuerkoushuang) gargle, keep it 3 times a day. Frequent gargle can make the mouth moist and clear. Large debris and secretions reduce dental plaque. The action of gargle is also conducive to the movement of the muscles around the oral cavity and can promote the self-cleaning effect of the oral cavity. The method of gargle is to use the tongue up and down, left and right, and repeated stirring, each time gargle>3min. Using different gargles for gargle can achieve different purposes. Choosing different gargle frequencies according to the specific conditions of patients can effectively prevent and control the occurrence of oral complications.

Oral Nursing Methods of Patients with Oral Tracheal Intubation

In terms of oral care methods for patients with oral endotracheal intubation, domestic reports mainly have two views. One view is that oral cavity washing is better than oral scrubbing, and the other view is the opposite, that oral cavity washing is better than oral cavity washing. According to recent reports abroad, most nurses tend to use a foam swab to care for the patient’s oral cavity. However, because the foam swab cannot perform the scrubbing function, it cannot remove the dental plaque implanted on the teeth of critically ill patients. Ineffective nursing operations, patients will be affected by potentially fatal hospital infections. Therefore, many studies still recommend that nurses perform oral scrubs for patients at least once a day.

Regarding the frequency of oral care, domestic opinions differ. Some recommend every four hours, while others recommend twice a day. According to a foreign survey, 72% of nurses answered that oral care for non-tracheal patients uses two to three times a day. The number of oral care for patients undergoing tracheal intubation is five times a day or more. For ICU patients, moisturizing the mouth two to four times an hour can relieve mucosal dryness. The number of oral care is at least three times a day.

Analyzing the literature on oral care of patients with oral endotracheal intubation at home and abroad, the selected liquid is the gingivitis irrigator (Jiuerkoushuang), although it is effective in preventing respiratory infections in cardiac surgery patients, but it is effective for patients with other diseases The effect is still lack of systematic research. In terms of methods, foreign studies have found that simple oral rinsing cannot effectively remove plaque from patients. Only oral scrubs can effectively remove plaque. It is recommended to perform oral scrubs for patients at least once a day. On the other hand, domestic studies have found Oral scrubbing alone cannot thoroughly clean special parts such as the oropharyngeal area. It can be seen that it is very necessary to rinse the parts that are difficult to scrub. On the frequency of oral care, the data that has been consulted is the conclusion drawn by the nursing staff based on clinical observation and clinical experience. As for when patients with oral endotracheal intubation begin oral care, there is currently no report.


to sum up

The oral cavity is one of the pathways for pathogenic microorganisms to invade the human body. The temperature, humidity and food residues of the oral cavity are most suitable for the growth and reproduction of microorganisms. Due to low body resistance and reduced drinking and eating, patients can often create conditions for the proliferation of microorganisms in the oral cavity, which can easily cause stomatitis, make the oral cavity smelly, affect appetite and digestive function, and even cause mumps and otitis media due to infection. The occurrence of disease. Consistently using the gingivitis irrigator (Jiuerkou Shuang) every day can effectively inhibit the production of various gingivitis mediators, improve periodontal health, inhibit the formation of dental plaque, reduce bleeding from the gums, and it is against Staphylococcus aureus, etc. Strong inhibitory effect, consistent use can effectively prevent periodontitis, gingivitis, dental caries, oral ulcers, respiratory tract infections, etc. It is suitable for oral care of pregnant women and patients after surgery and patients undergoing chemotherapy. Therefore, oral hygiene is closely related to human health.

For critically ill patients undergoing oral endotracheal intubation, it is still necessary to determine the most ideal oral care plan through rigorous clinical controlled studies, including the use, process, method, frequency, etc. of the gingivitis irrigator; at the same time, research is also required Clarify the impact of oral care measures on the prognosis of patients.

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