Protocols for the Most Common Diseases in Primary Healthcare Facilities

1-  Patient Assessment:

-       Perform a physical assessment of the different body systems.

-       Assess pain and notify the physician if the pain score is 3 or higher.

-       Perform a fall-risk assessment.

-       Conduct psychological, spiritual, and nutritional assessments.

-       Perform a geriatric assessment if the patient is 65 years of age or older.

-       Reassess pain immediately after extraction.

2-  Nursing Procedures:

-       Measure vital signs (blood pressure, temperature, pulse, and respiratory rate).

-       Measure the blood glucose level and notify the physician of the result.

-       Measure height and weight and calculate body mass index.

-       Develop and implement a nursing care plan.

-       Complete electronic documentation of all nursing forms in the system.

-       Administer treatment as prescribed by the physician.

3-  Health Education:

-       Educate the patient about measures to follow before and after tooth extraction:

 

Pre- and post-extraction instructions provide several health benefits. Following them helps relieve pain more quickly, avoid complications such as infection, and accelerate wound healing.

Health Education

1. Avoid rinsing the mouth

●      On the day of extraction, avoid rinsing or gargling with liquids and avoid spitting. Do not swallow saliva in the mouth, even if it has a slight taste of blood.

●      Spitting or rinsing may dislodge the blood clot formed at the extraction site, slowing healing and potentially causing severe pain later.

2. Apply a gauze pad

●      Bite firmly on the gauze pad placed over the extraction site for at least 30 minutes, using the opposing jaw to maintain pressure, and avoid speaking.

3. Stop smoking

●      On the day of extraction, refrain from smoking for at least 3 hours after the procedure. Preferably, avoid smoking for 24 hours after extraction.

4. Refrain from eating

●      Do not eat for two hours after tooth extraction. Thereafter, eat soft foods that are cold or lukewarm.

●      Do not consume hot food or beverages. Food should preferably not contain hard particles such as nuts.

5. Avoid strenuous physical exercise

●      On the day of extraction, avoid vigorous physical activity such as running, cycling, swimming, and similar activities. Also avoid prolonged exposure to sunlight.

6. Apply black tea

●      If bleeding occurs, gently rinse the mouth with cold water, then place a gauze pad soaked in black-tea extract—or a plain black-tea bag with all attachments removed and soaked in water—over the site.

●      Apply pressure with the tea bag against the extraction site for 30 minutes. Black tea contains substances that help constrict blood vessels and control bleeding.

7. Apply ice

●      After surgical tooth extraction, place ice in a plastic bag wrapped in a towel or other cloth and apply it to the cheek over the extraction area for 10 minutes. Remove it for 10 minutes, then reapply it for another 10 minutes. This helps reduce swelling.

8. Rinse the mouth on the day after extraction

●      Beginning one day after extraction, rinse the mouth after every meal and before bedtime, at least twice daily for one week.

●      Rinse with half a cup of lukewarm water containing one-quarter teaspoon of salt, or with a weak chamomile-tea solution.

9. Insert a denture

●      If a denture is inserted immediately after extraction, do not remove it during the first 24 hours except for a few minutes to rinse away food debris.

10. Consult the physician

●      If unusual problems occur, such as bleeding or a severe headache, consult the physician immediately.

References:

•        Bado,F.M.R.,Rebustini,F.,Azzi,R.G.,Ferreira, L.C.M., Souza,G.A.D.,Jamieson, L., &Mialhe, F.L. (2020). Cross-cultural adaptation and validataion of the Self-efficacy Scale to Brush Teeth at Night. Ciencia& Sauda Coletiva, 25, 4401-4410

Nurse’s Role in Caring for a Patient with a Dental Abscess

4-  Patient Assessment:

-       Perform a physical assessment of the different body systems.

-       Assess pain and notify the physician if the pain score is 3 or higher.

-       Perform a fall-risk assessment.

-       Conduct psychological, spiritual, and nutritional assessments.

-       Perform a geriatric assessment if the patient is 65 years of age or older.

5-  Nursing Procedures:

-       Measure vital signs (blood pressure, temperature, pulse, and respiratory rate).

-       Measure the blood glucose level and notify the physician of the result.

-       Measure height and weight and calculate body mass index.

-       Develop and implement a nursing care plan.

-       Complete electronic documentation of all nursing forms in the system.

6-  Health Education:

-       Explain the concept of a dental abscess to the patient:

A dental abscess is a pocket of pus, usually caused by a bacterial infection. It forms around the root of the affected tooth and requires treatment to prevent spread to the jaw. It is also referred to as a periapical or internal dental abscess and may cause severe pain that sometimes radiates to the ear or neck. If untreated, a dental abscess can rapidly become a serious condition.

-       Explain the types of dental abscess to the patient:

Different types of dental abscess may result from different causes and appear in various locations around the tooth. The most common types are:

-  Periapical abscess: An abscess at the tip or apex of the tooth root.

-  Periodontal abscess: An abscess in the gum beside the tooth root that may spread to surrounding tissues and bone.

-  Gingival abscess: An abscess affecting only the gingival tissue without involving the tooth or periodontal ligament. A periapical dental abscess usually results from untreated dental caries and may spread to surrounding tissues and bone.

-       Educate the patient about the symptoms of a dental abscess:

Pain around the tooth or in the gum is a principal symptom of a dental abscess. Sudden pain may worsen over time if the abscess is left untreated. Other symptoms associated with an abscessed tooth include:

-        Toothache or pain radiating to the jaw, ear, or neck.

-        Pain when chewing or biting.

-        Swollen gums.

-        An unpleasant taste in the mouth or bad breath.

-        Tooth and gum sensitivity.

-        Fever.

-        Enlarged lymph nodes under the jaw or in the neck.

-        Increased pain when lying down.

-        Difficulty swallowing or breathing.

-        Sensitivity to hot and cold beverages.

-        Swelling of the face or cheek.

-        A pimple-like bump on the gum.

- Educate the patient about treatment of a dental abscess:

Treatment focuses on eliminating the infection and relieving pain. Depending on the symptoms, the dentist may begin with a dental X-ray to determine whether the infection has spread. A gum or tooth abscess is usually treated by drainage and elimination of the infection. Extraction of the affected tooth may be necessary if it cannot be saved by root-canal treatment. Antibiotics may be used if the infection has already spread around the involved teeth or if the immune system is weakened.

-       Educate the patient about preventing a dental abscess:

Following a comprehensive oral-hygiene routine to prevent tooth decay is essential for preventing dental abscesses. Recommended measures include:

-        Use fluoride toothpaste and brush the teeth twice daily.

-        Replace the toothbrush every 3–4 months.

-        Eat a healthy diet and avoid foods high in sugar and starch.

-        Schedule regular dental visits for examinations and professional cleaning.

-        Use an antiseptic mouthwash regularly.

Correct daily brushing with a toothbrush and toothpaste is the most important measure for maintaining oral and dental hygiene and preventing caries and resulting diseases. Proper toothbrush care is also important for maintaining a clean, healthy mouth. Dental health is a principal component of oral health and prevention and plays an important role in improving overall health.

1. Selecting a toothbrush

The size and shape of the toothbrush should suit the mouth and allow it to reach all tooth surfaces easily. It should have soft nylon bristles to avoid injuring or scratching the gums and teeth.

2. Selecting toothpaste:

All toothpastes share basic ingredients but differ in certain additional components, some of which may be more beneficial than others. Therefore,

consider the following when purchasing toothpaste:

·       It should contain fluoride, which helps prevent tooth decay.

·       Some toothpastes are intended for special situations, such as whitening toothpaste and toothpaste for sensitive teeth. Consultation with a dentist is recommended before use.

3-   Replacing the toothbrush

Replace the toothbrush every three to four months or when the bristles become frayed to maintain cleaning effectiveness and prevent injury to gingival tissues.

4-   Duration of tooth brushing

Brush the teeth twice daily for two minutes each time. Avoid brushing immediately after consuming citrus fruits to protect the enamel layer.

Guidelines for Toothbrush Care

·       Do not share toothbrushes with others, because bacteria can be transmitted from one person to another, increasing the risk of infection, particularly in immunocompromised individuals.

·       Rinse the toothbrush thoroughly with water after use.

·       Store the toothbrush upright after cleaning to accelerate drying. If it is kept near other toothbrushes, ensure that the heads do not touch to prevent bacterial transmission between them.

·       Avoid covering the toothbrush unnecessarily, such as placing it in a case, and do not store it in enclosed spaces, because a moist environment promotes bacterial growth.

·       Do not attempt to sterilize the toothbrush by placing it in a dishwasher or microwave, because this may damage it.

·       No studies have established that soaking a toothbrush in mouthwash or a toothbrush sanitizer provides additional benefits or causes harm to oral health.

Steps for Brushing the Teeth

The appropriate brushing technique varies according to the person’s condition and age. A dentist can explain the suitable method. In general, use the toothbrush as follows:

·       Position the toothbrush at a 45-degree angle so that the bristles touch the gum line and the teeth.

·       Gently brush two or three teeth at a time with a back-and-forth motion from the gum line to the end of the tooth, then repeat for the remaining teeth.

·       Clean the posterior teeth (molars) by holding the brush at a 45-degree angle and using back-and-forth and circular movements over all inner surfaces.

·       Clean the inner surfaces of the teeth with the tip of the brush, moving it vertically upward and downward.

·       Clean the biting edges of the teeth, then clean the tongue using a tongue cleaner or the toothbrush.

  

References:

- https://www.merckmanuals.com/home/quick-facts-mouth-and-dental-disorders/tooth-disorders/dental-abscess Open link in new window

- https://www.nhs.uk/conditions/dental-abscess/ Open link in new window

- https://www.nidcr.nih.gov/health-info/tooth-decay/more-info/more-info Open link in new window

- https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dry-mouth-syndrome

- Bado,F.M.R.,Rebustini,F.,Azzi,R.G.,Ferreira, L.C.M., Souza,G.A.D.,Jamieson, L., &Mialhe, F.L. (2020). Cross-cultural adaptation and validataion of the Self-efficacy Scale to Brush Teeth at Night. Ciencia& Sauda Coletiva, 25, 4401-4410

Nurse’s Role in Caring for a Patient with Dental Calculus Accumulation

1-  Patient Assessment:

-       Perform a physical assessment of the different body systems.

-       Assess pain and notify the physician if the pain score is 3 or higher.

-       Perform a fall-risk assessment.

-       Conduct psychological, spiritual, and nutritional assessments.

-       Perform a geriatric assessment if the patient is 65 years of age or older.

2-  Nursing Procedures:

-       Measure vital signs (blood pressure, temperature, pulse, and respiratory rate).

-       Measure the blood glucose level and notify the physician of the result.

-       Measure height and weight and calculate body mass index.

-       Develop and implement a nursing care plan.

-       Complete electronic documentation of all nursing forms in the system.

3-  Health Education:

-       Explain the concept of dental calculus to the patient:

Dental calculus is a hard, rough layer that forms on the teeth as a result of accumulated plaque and minerals. It may be deposited on the visible portion of the tooth or below the gum line and appears yellow or brown. The posterior surfaces of the teeth and the spaces between teeth are common sites of accumulation. Because calculus is extremely hard, it cannot be removed by tooth brushing and must be removed by a dentist using special instruments. If left untreated, it may adversely affect gum and dental health.

-       Explain the causes of dental calculus to the patient:

Calculus forms when inadequate oral hygiene allows plaque to accumulate on the teeth. Plaque is a thin film composed of sugary and starchy food residues mixed with bacteria that live in the mouth. Over time, minerals from saliva are deposited within the plaque, causing it to harden into dental calculus.

-       Explain the symptoms of dental calculus to the patient:

·      Symptoms include hard, rough deposits on the teeth, particularly near the gums or between the teeth. The deposits may appear yellow or brown because calculus is porous and becomes stained by foods and beverages.

·      Bad breath.

·      Swollen gums that bleed easily.

·      Tooth sensitivity.

-       Explain treatment of dental calculus to the patient:

Treatment involves professional removal using specialized ultrasonic or manual instruments, followed by deep cleaning of the enamel surface.

-       Educate the patient about preventing dental calculus:

Correct daily brushing with a toothbrush and toothpaste is the most important measure for maintaining oral and dental hygiene and preventing caries and resulting diseases. Proper toothbrush care is also important for maintaining a clean, healthy mouth. Dental health is a principal component of oral health and prevention and plays an important role in improving overall health.

1. Selecting a toothbrush

The size and shape of the toothbrush should suit the mouth and allow it to reach all tooth surfaces easily. It should have soft nylon bristles to avoid injuring or scratching the gums and teeth.

2. Selecting toothpaste:

All toothpastes share basic ingredients but differ in certain additional components, some of which may be more beneficial than others. Therefore,

consider the following when purchasing toothpaste:

·      It should contain fluoride, which helps prevent tooth decay.

·      Some toothpastes are intended for special situations, such as whitening toothpaste and toothpaste for sensitive teeth. Consultation with a dentist is recommended before use.

3-  Replacing the toothbrush

Replace the toothbrush every three to four months or when the bristles become frayed to maintain cleaning effectiveness and prevent injury to gingival tissues.

4-  Duration of tooth brushing

Brush the teeth twice daily for two minutes each time. Avoid brushing immediately after consuming citrus fruits to protect the enamel layer.

Guidelines for Toothbrush Care

× Do not share toothbrushes with others, because bacteria can be transmitted from one person to another, increasing the risk of infection, particularly in immunocompromised individuals.

- Rinse the toothbrush thoroughly with water after use.

- Store the toothbrush upright after cleaning to accelerate drying. If it is kept near other toothbrushes, ensure that the heads do not touch to prevent bacterial transmission between them.

- Avoid covering the toothbrush unnecessarily, such as placing it in a case, and do not store it in enclosed spaces, because a moist environment promotes bacterial growth.

- Do not attempt to sterilize the toothbrush by placing it in a dishwasher or microwave, because this may damage it.

-No studies have established that soaking a toothbrush in mouthwash or a toothbrush sanitizer provides additional benefits or causes harm to oral health.

Steps for Brushing the Teeth

The appropriate brushing technique varies according to the person’s condition and age. A dentist can explain the suitable method. In general, use the toothbrush as follows:

·       Position the toothbrush at a 45-degree angle so that the bristles touch the gum line and the teeth.

·       Gently brush two or three teeth at a time with a back-and-forth motion from the gum line to the end of the tooth, then repeat for the remaining teeth.

·       Clean the posterior teeth (molars) by holding the brush at a 45-degree angle and using back-and-forth and circular movements over all inner surfaces.

·       Clean the inner surfaces of the teeth with the tip of the brush, moving it vertically upward and downward.

·       Clean the biting edges of the teeth, then clean the tongue using a tongue cleaner or the toothbrush.

References:

·       Candice Abellon. How to Remove Plaque and Tartar. Retrieved on the 28th of December, 2023

·        Sara Lindberg. What’s the Difference Between Plaque and Tartar? Retrieved on the 28th of December, 2023.

·       Aaron Clarius. Dental Calculus Causes & Treatment. Retrieved on the 28th of December, 2023.

·       Zawn Villines. What are the differences between plaque and tartar? Retrieved on the 28th of December, 2023.

·       Elizabeth Pratt. Plaque Removal and Preventing Tartar Buildup on Teeth. Retrieved on the 28th of December, 2023.

·       Bado,F.M.R.,Rebustini,F.,Azzi,R.G.,Ferreira, L.C.M., Souza,G.A.D.,Jamieson, L., &Mialhe, F.L. (2020). Cross-cultural adaptation and validataion of the Self-efficacy Scale to Brush Teeth at Night. Ciencia& Sauda Coletiva, 25, 4401-4410