Download oral hygiene care recommendations for bc children`s hospital in

ORAL HYGIENE CARE RECOMMENDATIONS FOR
BC CHILDREN’S HOSPITAL IN-PATIENTS
ORAL HYGIENE CARE RECOMMENDATIONS
FOR BC CHILDREN’S HOSPITAL IN-PATIENTS
These oral hygiene recommendations are presented as a general guideline for caregivers and
health care providers of in-patients. In-patients at most risk for acute oral health concerns are
those patients undergoing oncologic therapy or invasive surgical care leading to longer term
hospital stays. Therefore the recommendations and comments below are mostly applicable to
those groups.
In all cases, if there is a concern about the oral health status of any in-patient, Dentistry would be
happy to provide consultation upon request; please feel free to fax a consultation request to the
Dentistry Clinic at 2812.
DENTAL CARE:
Referral to Dentistry may be appropriate to:
•
•
•
•
•
Identify patients at risk for developing dental caries and/or oral mucositis
Identify patients who need additional dental work prior to, or during their care
Screen all pediatric patients admitted for major surgery (eg. cardiac, orthopedic surgical
procedures) or those presenting for oncology treatment – these patients should be
examined by a dentist prior to beginning treatment to rule out dental infection, to confirm
the patient is “fit” for their surgery
Screen all patients that have a history of head and neck radiation prior to major surgery or
beginning of oncology treatment
Screening prior to oncologic therapy (particularly Hematopoietic Cell Transplantation)
should be performed to confirm baseline dental status.
TOOTHBRUSHING:
Unless there are specific contraindications, toothbrushing should be completed at a
minimum frequency of twice daily.
For oncology patients, this could be increased to as frequently as after every meal if
signs of oral mucositis exist. Good oral hygiene reduces the risk of developing moderate
to severe mucositis.
Toothbrushing has been shown to be safely performed for patients with widely differing
ranges of platelet count; therefore thrombocytopenia should not be the sole determinant
for reduction of oral hygiene measures.
Toothbrushes
RECOMMENDED:
OH.12.1
BCCH Children’s Hospital and Youth Health Policy Manual
Effective Date: Jun-07-2017
Page 1 of 6
ORAL HYGIENE CARE RECOMMENDATIONS FOR
BC CHILDREN’S HOSPITAL IN-PATIENTS
•
•
•
•
•
Rounded soft or extra soft nylon bristle tips
Appropriate size – head length should be roughly equal to width of lower anterior teeth
therefore small heads for children under 6
Sonic or oscillating electric toothbrushes acceptable if the patient is experienced and
capable of using them without creating tissue trauma
Rinse bristles between each use with warm water and let dry
Replace toothbrush every 3 months or when bristles are worn/splayed; especially important
to replace after colds/upper respiratory/viral infections.
NOT RECOMMENDED:
•
•
•
•
•
Rotary electric toothbrushes - can create mucosa tears
Sponge “Toothettes” do NOT remove bacterial plaque and should not be used unless no
other options exist
Toothpicks and water-irrigating devices - due to increased risk of tissue trauma
Covering or capping of wet toothbrushes; this promotes microbial growth
Storing patient’s toothbrush in hospital room bathroom; exposes to bacterial
aerosols/contamination
Brushing Technique
• Brush for 2 minutes using a gentle rotating/circular motion, covering all surfaces
• Toothbrush at a 45 degree angle to the tooth surface with direct contact on gum-line area
• Rinsing with water during brushing helps with plaque removal
• For infants, introduce soft brush as soon as first tooth erupts Alternatively: use moist gauze
or washcloth
• Pre-dentate infants (no teeth yet): wipe gum pads after feeding
• Children younger than 6 yrs of age need help with brushing technique and should be
supervised/assisted by the caregiver
Toothpaste
•
•
•
•
•
OH.12.1
Patients unable to spit may use still use fluoridated toothpaste with supervision should it
be determined that they are at high risk for caries or dental problems
If flavored toothpaste is needed to make brushing more palatable bubblegum is the most
non irritating flavor and easiest to find
Avoid mint and cinnamon which is the most irritating
Avoid toothpastes that do not have the ADA / CDA seal
Avoid toothpastes that have pyrophosphate, hexametaphosphate,
cinnamon flavoring or sodium lauryl sulphate. Toothpastes
BCCH Children’s Hospital and Youth Health Policy Manual
Effective Date: Jun-07-2017
Page 2 of 6
ORAL HYGIENE CARE RECOMMENDATIONS FOR
BC CHILDREN’S HOSPITAL IN-PATIENTS
•
labeled whitening, brightening or tartar control should not be used for children under 12
years of age
Amounts (see photo below): “grain of rice” for <3 yrs; “pea sized” amount for 3 to 6 yrs;
excessive amounts are wasteful and can be unnecessarily ingested
FLUORIDE:
Additional “topical” fluoride may be encouraged for patients identified by Dentistry as “high risk” for
dental caries due to dry mouth or other presenting conditions. Professional topical applications of
fluoride (eg. Varnishes) are preferred for children with special health care needs and considered
most efficacious.
Prescription for systemic fluoride drops, tablets or chewables must be given by a dentist or
physician in consideration of all other sources of fluoride intake. Excessive amounts of systemic
fluoride over an extended period of time in young children can increase a child’s risk of having
permanent enamel mottling known as “dental fluorosis.”
OH.12.1
BCCH Children’s Hospital and Youth Health Policy Manual
Effective Date: Jun-07-2017
Page 3 of 6
ORAL HYGIENE CARE RECOMMENDATIONS FOR
BC CHILDREN’S HOSPITAL IN-PATIENTS
FLOSSING:
In general, waxed floss is preferred as it slides easier than unwaxed and is less likely to cause
tissue trauma
• Floss aids with handles tend to cause more mucosal injury, unless technique has been
mastered
• Children should have parent flossing introduced as soon as the back molar teeth are in
side-to-side contact (usually around 3 to 4 years of age)
• Avoid flossing sore areas and/or areas that have active ulceration or bleeding
• Use caution when patient’s platelet count less than 50,000/mm3 or ANC less than 1.0 and
only if the parent/patient is competent in technique
• Do NOT floss when platelet counts are less than 20,000/mm3
Frequency
Once daily
LIP CARE:
•
•
•
Assess regularly for dry and cracked areas
Lanolin products (unless allergic) are encouraged to moisturize and protect lips against
damage; patients of all ages may use lanolin products but must be removed before
radiation
Do not use Chapstick, plain KY jelly, occlusive lip balms or petroleum-based products as
these moisturizers could promote bacterial growth
ORAL RINSES:
For mucosal irritations (as per patient tolerance) use:
• Salt and soda rinses (mix ¼ tsp of salt, ½ tsp of sodium bicarbonate and ½ cup warm water
• Salt water rinses
• Baking soda rinses (if salt is irritating the oral mucosa)
Avoid mouthwashes that contain alcohol (including chlorohexidine rinses that contain alcohol).
This dries and irritates tissue and may interfere with wound healing. Chlorhexidine rinses may
stain teeth and alter taste sensation. Rinses containing topical anesthetic agents (eg. Lidocaine)
should be used with caution due to risks of aspiration and possible toxicity (if multiple mouth
ulcerations).
Frequency
Four times a day (begin when mucosa becomes inflamed)
Use in conjunction with oral hygiene regimen, not in place of
Technique
Encourage patients who are not at risk for aspiration to gargle
rather than rinsing as this helps clear the secretions that
adhere to the base of the tongue or oropharynx.
OH.12.1
BCCH Children’s Hospital and Youth Health Policy Manual
Effective Date: Jun-07-2017
Page 4 of 6
ORAL HYGIENE CARE RECOMMENDATIONS FOR
BC CHILDREN’S HOSPITAL IN-PATIENTS
Rinsing the mouth with plain water should be encouraged especially after vomiting or taking
medications high in sugar content
DIETARY CONSIDERATIONS:
When the oral tissues are in sub-optimal condition (due to mucositis or oral ulceration):
•
•
•
•
Choose soft, easy to chew foods
Allow hot foods to cool before eating
Identify patients at risk for malnutrition; the incidence of gum conditions and poor oral
healing increases with impaired nutritional status
Identify ways to safely increase nutritional intake
Avoid:
• foods with sharp edges (chips, dry crackers)
• very spicy, sour, or acidic foods/drinks
• sugary food/drinks
• foods that stick to teeth
• alcohol
DENTURES & APPLIANCES:
•
•
•
•
•
•
•
If dentures are irritating the oral mucosa, wear dentures only when eating foods that need
to be chewed to facilitate proper healing
Avoid wearing dentures if mouth sores are present under the dentures
Denture adhesives should not be used
Do not let patients wear loose dentures
Wait 6-12 months after head and neck radiation before obtaining a
new denture because radiation can cause mouth and jaw changes
Fixed appliances (braces or poorly-fitting appliances/spacers) should be removed by a
dentist prior to chemotherapy or radiation
Removable orthodontic appliances and retainers that fit well may be worn as tolerated by
patient who maintains good oral care
Denture/Appliance Care
•
•
•
•
OH.12.1
Clean with a denture brush/toothbrush and regular toothpaste at least once a day or after
meals
Always have dentures/acrylic appliances stored in water if not being worn during
hospitalization
Clean storage container with soap and water or antimicrobial solution between uses and
change any disposable storage container supplied by the hospital at least once per week
Rinse off cleansing agents before inserting dentures/appliances in mouth
BCCH Children’s Hospital and Youth Health Policy Manual
Effective Date: Jun-07-2017
Page 5 of 6
ORAL HYGIENE CARE RECOMMENDATIONS FOR
BC CHILDREN’S HOSPITAL IN-PATIENTS
HOME CARE (for the short-term period after discharge):
Instruct patients/families to examine the oral mucosa carefully when performing oral care and
notify the health care team of any of the following:
• Sores
• Swelling
• Bleeding
• Pain
• Sticky white film
At discharge, consult with the patient’s most responsible physician regarding best timing to
resume routine dental care visits with the community-based family dentist, or whether it is more
appropriate for Dentistry to continue following the patient.
References:
American Academy of Pediatric Dentistry: Policy on medically necessary care. Pediatric Dentistry
Sp Issue 16/17 Vol 38 no. 6. Pages 18-22.
Da Fonseca, MA. Dental care of the pediatric cancer patient. Pediatr Dent: 2004;26:53-57.
American Academy of Pediatric Dentistry: Guideline on management of dental patients with
special health care needs. Pediatric Dentistry Sp Issue 16/17 Vol 38 no. 6. Page 171-176.
American Academy of Pediatric Dentistry: Guideline on antibiotic prophylaxis for dental patients at
risk for infection. Pediatric Dentistry Sp Issue 14/15 Vol 38 no. 6. Page 328-333.
Kholoud A, Alaizari A, Tarakji B, Petro W, Hussain K, Altamimi M. Dental considerations for
leukemic pediatric patients: An updated review for general dental practitioner. Mater Sociomed.
2015 Oct;27(5):359-62.
Guideline on dental management of pediatric patients receiving chemotherarpy, hematopoietic cell
transplantation and/or radiation therapy. Clinical Practice Guidelines of the American Academy of
Pediatric Dentistry. Pediatric Dentistry Sp Issue 16/17 Vol 38 no. 6. Page 334-342.
OH.12.1
BCCH Children’s Hospital and Youth Health Policy Manual
Effective Date: Jun-07-2017
Page 6 of 6