Oral care swabs are disposable, single-use oral care sponges attached to a stick. They are used for oral care in the hospital and long-term care setting. [1] Disposable oral care swabs may also be known by other various names, such as sponge swab, [2] swabs for oral care, [2] foam swab, [3] mouth swab, [4] oral swabstick,[ citation needed ] and the trademark name Toothette.[ citation needed ]
The Toothette is meant to moisten and clear the oral cavity of food debris and thickened saliva associated with xerostomia (dry mouth). [1] [2] Most importantly, the oral care swab's intended use is as an adjunct to other oral care tools (toothbrush and interdental cleaners) in the hospital and long-term care setting. It is especially useful when caring for the oral health of intubated and palliative care patients, and is recommended for individuals who are receiving radiation therapy, chemotherapy, bone marrow transplants, or are immunosuppressed. [1] The American Dental Association, [1] approved the Toothette Plus Oral Swab with Sodium Bicarbonate and the Toothette Oral Care Single Use System in May 2002, stating the “Toothette Oral Care Single Use System/Toothette Plus Oral Swab is accepted as an effective oral cleansing device for individuals who have difficulty practicing normal oral hygiene”. [1]
Oral swabs and other foam swabs are effective at stimulating the tissue between oral care, and are used for patients who are unable to care for their own oral health. [1] [5] Oral swabs are especially helpful when a patient suffers from gross mucositis, potentially arising from chemotherapy. [6] This is because the oral swabs can apply moisture to the oral cavity, therefore soothing the tissues. [6] Additionally, oral care swabs are indicated when toothbrushing is contraindicated, particularly when an individual's platelet counts are below 40000-50000 and when there are issues accessing the oral cavity. [6] It is also necessary to use oral swabs for oral care when an individual has thrombocytopenia in order to reduce risk of exacerbated bleeding. [7]
Often oral health education and training is limited for healthcare aids and nurses, leading to suboptimal oral care for dependent patients in long-term care and hospital settings. [2] [4] [8] The oral care swab is inaccurately used in the long-term care and hospital setting as the predominant tool for oral care, and toothbrushes are rarely used [2] [5] [4] Grap et al. [5] found that nursing staff in an intensive care unit most commonly use oral care swabs and mouthwash as the predominant tool for oral care, especially for intubated patients. This is concerning because it is well-established that the oral care swab does not effectively remove oral biofilm, and the toothbrush is significantly better at promoting health of the gums and controlling oral biofilm. [3] [5] [4] When the efficacy of the toothbrush and oral care swab are compared, the toothbrush is better at removing plaque from the oral cavity. [3]
The current oral care practices of nursing staff in the long-term care and hospital setting do not reflect evidence-based recommendations present in the literature. [1] [2] [3] [5] [9] The American Dental Association [1] cautioned “[the oral care swab] does not substitute for daily brushing and flossing for effective plaque removal from teeth and, when possible, should be used in conjunction with brushing and flossing.” Additionally, nursing mouth care policy for the Health Care Corporation of St. Johns [9] reflects a similar perspective with a nursing alert stating: “Toothettes are not recommended as a substitute for a toothbrush”. Dalhousie University’s report, Brushing up on mouth care: An oral health resource for those who provide care to older adults, [10] further cautioned that the sponge end of oral care swabs does not have the ability to mechanical remove oral biofilm from the teeth and gums because it is too soft. They further elaborate on how the toothbrush performs significantly better in promoting healing of the gums, and state that “toothbrushes are safe and effective for removing debris and plaque from all oral tissues, including the tongue, palate, cheeks and teeth”. [10]
Effective oral biofilm control on a regular basis is a therapeutic intervention to reduce the risk of developing numerous systemic diseases, such as diabetes mellitus, cardiovascular disease, and aspiration pneumonia due to poor oral health. [2] [5] Therefore, it is essential that oral care policies of hospitals and long-term care settings discourage the use of oral care swabs as the sole tool for oral biofilm control. [1] [2] [9] When used properly, toothbrushing and devices for interdental cleaning are well-established tools for regular plaque removal, and should be the predominant oral care tools used in the hospital and long-term care setting. [2] [3] [5] [4] The oral care swab can be used as an adjunct to toothbrushing and flossing to moisten and clear the oral cavity of food debris and thickened saliva associated with dry mouth. [1] [2]
Oral care swabs, when used improperly, pose significant health risks. They are a choking hazard because the sponge end can dislodge and be aspirated during use. [2] [10] On September 22, 2015 Health England Education Board banned sponge swabs from being used in the hospital and long-term care setting due to 800 safety incidents associated with their use, even causing the death of a patient in one case.[ citation needed ]
Initially lemon glycerine swabs were used to aid in saliva production. [5] However, it was noted that they caused irritation and enamel decalcification due to the acidity of the lemon. [8] [10] The combination of these factors lead to recurring dry mouth, [5] counteracting the initial reason for its use. Due to their drying effect, the swabs were also ineffective in preventing dry lips. [8] Therefore, the nursing mouth care policy for the Health Care Corporation of St. Johns recommended discontinuing use of lemon glycerine swabs for oral care due to its adverse effects. [9] The evidence contraindicates the use of lemon glycerine swabstick for individuals suffering from dry mouth. [6]
Mouthwash, mouth rinse, oral rinse, or mouth bath is a liquid which is held in the mouth passively or swilled around the mouth by contraction of the perioral muscles and/or movement of the head, and may be gargled, where the head is tilted back and the liquid bubbled at the back of the mouth.
A toothbrush is an oral hygiene tool used to clean the teeth, gums, and tongue. It consists of a head of tightly clustered bristles, atop of which toothpaste can be applied, mounted on a handle which facilitates the cleaning of hard-to-reach areas of the mouth. They should be used in conjunction with something to clean between the teeth where the bristles of the toothbrush cannot reach - for example floss, tape or interdental brushes.
In dentistry, calculus or tartar is a form of hardened dental plaque. It is caused by precipitation of minerals from saliva and gingival crevicular fluid (GCF) in plaque on the teeth. This process of precipitation kills the bacterial cells within dental plaque, but the rough and hardened surface that is formed provides an ideal surface for further plaque formation. This leads to calculus buildup, which compromises the health of the gingiva (gums). Calculus can form both along the gumline, where it is referred to as supragingival, and within the narrow sulcus that exists between the teeth and the gingiva, where it is referred to as subgingival.
Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation.
An electric toothbrush is a toothbrush that makes rapid automatic bristle motions, either back-and-forth oscillation or rotation-oscillation, in order to clean teeth. Motions at sonic speeds or below are made by a motor. In the case of ultrasonic toothbrushes, ultrasonic motions are produced by a piezoelectric crystal. A modern electric toothbrush is usually powered by a rechargeable battery charged through inductive charging when the brush sits in the charging base between uses.
Streptococcus mutans is a facultatively anaerobic, gram-positive coccus commonly found in the human oral cavity and is a significant contributor to tooth decay. It is part of the "streptococci", an informal general name for all species in the genus Streptococcus. The microbe was first described by James Kilian Clarke in 1924.
Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.
Dental plaque is a biofilm of microorganisms that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it is often brown or pale yellow. It is commonly found between the teeth, on the front of teeth, behind teeth, on chewing surfaces, along the gumline (supragingival), or below the gumline cervical margins (subgingival). Dental plaque is also known as microbial plaque, oral biofilm, dental biofilm, dental plaque biofilm or bacterial plaque biofilm. Bacterial plaque is one of the major causes for dental decay and gum disease.
An oral irrigator is a home dental care device which uses a stream of high-pressure pulsating water intended to remove dental plaque and food debris between teeth and below the gum line. Regular use of an oral irrigator is believed to improve gingival health. The devices may also provide easier cleaning for braces and dental implants. However, more research is needed to confirm plaque biofilm removal and effectiveness when used by patients with special oral or systemic health needs.
Tooth brushing is the act of scrubbing teeth with a toothbrush, usually equipped with toothpaste. Interdental cleaning can be useful with tooth brushing, and together these two activities are the primary means of cleaning teeth, one of the main aspects of oral hygiene.
Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus and then smoothing, or planing, of the (exposed) surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the agents that cause inflammation. It is a part of non-surgical periodontal therapy. This helps to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.
Oral microbiology is the study of the microorganisms (microbiota) of the oral cavity and their interactions between oral microorganisms or with the host. The environment present in the human mouth is suited to the growth of characteristic microorganisms found there. It provides a source of water and nutrients, as well as a moderate temperature. Resident microbes of the mouth adhere to the teeth and gums to resist mechanical flushing from the mouth to stomach where acid-sensitive microbes are destroyed by hydrochloric acid.
Dental Public Health (DPH) is a para-clinical specialty of dentistry that deals with the prevention of oral disease and promotion of oral health. Dental public health is involved in the assessment of key dental health needs and coming up with effective solutions to improve the dental health of populations rather than individuals.
Oral hygiene is the practice of keeping one's mouth clean and free of disease and other problems by regular brushing of the teeth and cleaning between the teeth. It is important that oral hygiene be carried out on a regular basis to enable prevention of dental disease and bad breath. The most common types of dental disease are tooth decay and gum diseases, including gingivitis, and periodontitis.
Oral and maxillofacial pathology refers to the diseases of the mouth, jaws and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral skin. The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.
Tooth remineralization is the natural repair process for non-cavitated tooth lesions, in which calcium, phosphate and sometimes fluoride ions are deposited into crystal voids in demineralised enamel. Remineralization can contribute towards restoring strength and function within tooth structure.
Gingivitis is a non-destructive disease that causes inflammation of the gums. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms that is attached to tooth surfaces, termed plaque-induced gingivitis. Most forms of gingivitis are plaque-induced.
Oral ecology refers to the organisms that live in a mouth. Bacteria in biofilm were first detected under the microscopes of Antony van Leeuwenhoek in the 17th century. Various bacteria and saliva are two of the major components in oral microbiology, having the capability to be harmful, but also performing beneficial and necessary roles in the immune system. Proper oral hygiene aims to control the harmful effects and prevent disease transmission.
Biotene is a dental hygiene product originally manufactured by Laclede Inc. but now marketed by Haleon. It comes in a number of forms, including toothpaste, mouthwash and gel.
Atraumatic Restorative Treatment (ART) is a method for cleaning out tooth decay from teeth using only hand instruments and placing a filling. It does not use rotary dental instruments to prepare the tooth and can be placed in settings with no access to dental equipment. No drilling or local anaesthetic injections (LA) are required. ART is considered a conservative approach, not only because it removes the decayed tissue with hand instruments, avoiding removing more tissue necessary which preserves as much tooth structure as possible, but also because it avoids pulp irritation and minimises patient discomfort. ART can be used for small, medium and deep cavities caused by dental caries.