Registered Nurses' Association of Ontario

Oral Care for Patients with Diminished Health Status

  • This recommendation is in direct relationship to controlling the accumulation of plaque biofilm and halitosis. Halitosis (bad breath) is a common problem, predominantly affecting adults.
  • Unconscious or intubated clients should receive oral care every two to four hours, and as required.
  • Intubated clients should also be assessed to determine the need for removal of oropharyngeal secretions frequently, as well as prior to repositioning the tube or deflation of the endotracheal cuff.
  • It is generally recommended that tooth brushing occur in the morning after a period of sleep and again at night prior to going to bed.
  • Frequency of tooth brushing is dependent on the unpredictable rate of plaque biofilm accumulation and contributing factors such as:
    •  Smoking
    • Dietary intake
    • Systemic disease
    • Compromised immune systems or
    • An individual’s dexterity
  • In situations where clients have decreased level of consciousness or have special needs, caregivers should incorporate oral hygiene procedures into the care.
Clinical Management
Oral Health: Nursing Assessment and Intervention
Point of Care Resources