1. Prepared by : SIG, Dermatology Nursing IADVL

2. CONT…… Good oral hygiene has health and social benefits, and will help patients recover from illness

3. Importance Some dermatology diseases may only involve the oral cavity Some disorders may involve the oral cavity along with skin Some systemic disorders may involve the oral mucosa as well

4. CONT…. Oral nursing care is mostly important in disorders like Pemphigus Steven Johnson Sydrome Toxic epidermal necrolysis Severe oral candidiasis Sever herpetic gingivostomatitis Extensive aphthous ulcers

5. Aphthous ulcer

6. Pemphig vulgaris

7. Steven Johnson syndrome

8. Toxic epidermal necrolysis http://www.eijd.org/viewimage.asp?img=IndianJDermatol_2013_58_5_406_117319_f2.jpg

9. Role of nurses In patients who are able to carry out oral care themselves - should facilitate or prompt patients to carry out themselves at appropriate times (morning, night, after meals or after vomitting, more frequent if required) In bed ridden patients or who are not able to do themselves nurses should undertake oral care

10. Oral assessment Gain consent Wash hands Wear gloves and apron Maintain privacy. Assesst the oral cavity for the oral hygiene, dental hygiene, ulcers, growths, etc Use of torch, tongue depressor Recording of the problem

11. Oral care Gain consent Assemble equipment – toothbrush, toothpaste, clothing protection, glass of water for rinsing mouth, receiver, tissues, medications Position of patient: upright ( if patient needs to lie flat special care to avoid choking – turn patient’s head to the side and suction equipment if available) If patient can tolerate – brush the inner, outer and biting surfaces of the teeth with wet toothbrush with a small amount of toothpaste. Use a gentle rotational movement

12. Oral care – cont. If patient can’t tolerate the use of toothbrush (e.g extensive involvement with tenderness SJS/TEN)- mouthwash can be used instead Allow the patient to take mouthfuls of water, rinse the mouth and spit into the receiver. Use tissues to dry around the mouth Apply the medicine prescribed by the physician gently with a ear bud over the lesions

13. Oral care –.cont. Apply moisturizer to the patients lips Document the care you have given

14. How often should oral care be carried out??? As often as necessary Brushing the teeth at least twice daily Application of topical anaesthetic gel (containing Benzocaine) 15-20 minutes before each feed Rinsing the mouth with antibacterial rinse after each feeding ( if patient has tenderness anaesthetic rinse may be added) Applying antifungal/antibacterial creams/gels/lotions after rinsing