Is your mouth ready for hospital care?

Dental hygienist Tracey Kinsella highlights the utmost importance of optimum oral care during hospitalisation.

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Every January I start the New Year with a goal for self-improvement. The need to shed a few pounds is a regular one. I wonder how many people give oral care the importance it deserves as their New Year resolution?

As a dental hygienist I do 'practise what I preach'. I follow a strict routine of twice daily brushing, thorough interdental cleaning, retaining the fluoride toothpaste, do an oral 'self-check' and visit my dentist regularly. I do my best. I am very motivated and this is why... For the past 30 years, alongside my general practice positions, I have been a hospital dental hygienist.

The environments have involved being ward-based, working as part of a multi-disciplinary team. I provide oral care to individuals who are systemically unwell, those with neurological conditions and those who have experienced traumatic brain injury. I am currently providing education to a critical care team which has highlighted the importance of optimum oral hygiene during mechanical ventilation.

The British Society of Periodontology and Implant Dentistry (BSP) have been constant in raising awareness of the link between oral health and systemic health. The European Federation of Periodontology (EFP) comprises 37 national scientific societies of periodontology. The EFP Manifesto calls upon all dental and health professionals to act in the prevention, early diagnosis, and effective treatment of periodontal disease.¹ The Manifesto is well worth the read and it is empowering to join this mission with other like-minded dental and wider health professionals.

When I visit an individual with periodontal disease on the ward I do not see the mouth in isolation. I am aware that oral inflammation may be having an impact on the rest of the body.

The EFP Manifesto calls for a fundamental change in the perception of dental professionals' responsibilities with regard to achieving the general health of patients and affirms that patients' needs will best be met through collaborative development between the dental and medical communities in applying multidisciplinary approaches and guidelines for patient care, independently of a patient's presenting location, in order to combat the devastating oral and general health effects for the individual and society. The Manifesto describes that periodontal disease should be acknowledged as a major public health issue.

When I visit an individual with periodontal disease on the ward I do not see the mouth in isolation. I am aware that oral inflammation may be having an impact on the rest of the body.

I describe to nursing staff that they need to light the mouth up. The mouth needs to be visible when carrying out an oral assessment. The patient may be vulnerable and completely dependent on others for oral care. I witness how much care is dedicated to caring for other personal needs such as pressure sores and I share with nursing staff that the inflammatory surface area in the mouth cannot be seen so easily but requires focused attention too. Oral inflammation has been shown to increase systemic inflammatory burden.²

Evidence suggests that oral health deteriorates following admissions to hospitals, particularly in critical care settings.³ This deterioration affects quality of life and wellbeing and increases the risk of healthcare-associated infections (HCAIs).

HCAIs are common adverse events affecting patients during hospitalisation. Poor oral health is implicated as a factor in the development of hospital-acquired pneumonia (HAP). A complication when on critical care is that the endotracheal tube and incomplete mouth closing will alter the oral microenvironment. Ventilator-associated pneumonia is a common nosocomial infection in critical care. The oral biofilm provides a reservoir of respiratory pathogens and that subsequently may lead to pneumonia.⁴ Oral care during a stay on ICU is of utmost importance and raising awareness with nursing staff is vital.

Antimicrobial resistance is increasing, creating a new generation of superbugs that cannot be treated with existing medicines. I believe that as a profession we have the knowledge and ability to maintain a high level of cross infection control in our surgeries. Throughout the COVID-19 pandemic super dental nurses have been working with great dedication following the necessary fallow time, bleaching floors and carrying out an intense clean after each patient. I observe this also with the hospital housekeeping staff who put their all into minimising the risk for inpatients. However, healthcare-associated infections are a great challenge and pose a serious risk to all.

My mouth is ready for hospital care. I am reassured that it is well maintained if at some point I arrive on a hospital ward as a patient. So how about the person who arrives at hospital with existing dental disease and poor oral health? Will their health outcomes be impacted by their oral status? I know for certain that my advanced care plan will include that the nurses carry out twice daily toothbrushing for me, please, should I ever need their help. If we keep sharing the preventive advice, we can make a difference to patients' hospital stay.

Author information.

Tracey Kinsella RDH works with the Mouth Care Matters Team, Health Education England, as a staff hygienist at University Dental Hospital, Cardiff, and in general dental practice.