Oral Health and Hygiene Content in Nursing Fundamentals Textbooks

Table 1

Summary of Results.

Bibliographic data	Pages devoted to oral health and hhygiene	Total Pages*	Percent of oral health and hygiene content	Significant findings
				(i) Assessment was 0.25 page.
				(ii) Recommended cleaning dentures with soft-bristled toothbrush “because hard-bristled brushes can produce grooves in dentures” (page 722). Although this sentence is congruent with the American Dental Association guidelines [18, 19], it could be misconstrued as advising against using denture brushes, which tend to have firmer bristles than soft toothbrushes.
Craven and Hirnle [35]	4.5	1408	0.32%	(iii) Directed nursing student to use string floss, not floss heads or interdentate sticks.
				(iv) Suggested the use of a padded tongue blade oral to keep the mouth of an unconscious patient open.
				(v) Recommended either a soft toothbrush or foam swabs to brush teeth.
				(vi) Denture removal incongruent with published dental research.
				(i) Oral health assessment content did not address checking dentures for fit, integrity, or plaque.
				(ii) Recommended the use of foam swabs for “clients with impaired physical mobility or who are unconscious (comatose)” (page 759).
				(iii) No information on how to correctly floss or brush teeth, although the text provided a recipe for toothpaste: 2 parts salt and 1 part baking soda, no citations for this recipe.
				(iv) Recommended brushing dentures with toothpaste.
Delaune and Ladner [36]	8.5 with pictures	1391	0.61%	(v) Did not direct nurses to brush the bums of edentate patients with soft toothbrushes.
				(vi) Simultaneously recommended the use of foam sponges with toothpaste or toothbrushes with toothpaste.
				(vii) Confusing content in the area of flossing. For generic mouth care, solely advised the use of string floss for flossing. For patients who were comatose, directed the use of floss holders BUT also recommended against flossing teeth for patients fully dependent on nurses for care.
				(viii) Denture removal incongruent with published dental research.
				(i) Assessment content focused on the oral cavity (10 lines) but did not address normal versus abnormal findings.
				(ii) Included content specific to oral hygiene and persons with cognitive impairments consistent with published articles in this area by Chalmers [20–23].
				(iii) No mention of soft toothbrush, simply “toothbrush.”
				(iv) For assisting the patient, did recommend flossing, but technique was incorrect—recommended that the nurse use 6 inches of floss. Did recommend “a plastic floss holder” (page 338).
Lynn [38]	10	1042	0.96%	(v) Mouthwash is presented a simply a mechanism for “leaving a pleasant taste in the mouth” (page 338) instead as an adjuvant to prevent caries and gingivitis.
				(vi) Recommended use of a padded tongue blade to prop open the mouth of a “dependent” patient (page 341).
				(vii) For a dependent patient, recommended use of toothpaste and toothbrush.
				(viii) For a dependent patient, Remove dentures if present and use a foam swab or gauze-padded tongue blade “moistened with water or dilute mouthwash to gently clean gums, mucous membranes, and tongue.” (page 341).
				(ix) Denture removal incongruent with published dental research.
				(x) No direction about need to remove dentures overnight.
				(xi) Recommended toothpaste to brush dentures.
				(i) Out of all 7 textbooks, best description of oral health assessment (defined and described caries, periodontal disease, gingivitis; also addressed the components of an oral health assessment such as presence/absence of plaque quality of saliva and integrity of buccal mucosa).
				(ii) Oral-systemic link clearly articulated.
				(iii) Recommended brushing 4x/day.
				(iv) Stated that foam swabs) are ineffective and should not be used—but then, in procedure section, recommended foam swabs for unconscious or debilitated patients (page 889) and showed them in pictures.
Potter and Perry [37]	7.5	1408	0.53%	(v) Provided clearest instructions for oral care on an unconscious/mechanically ventilated patient.
				(vi) Recommended oral airway to keep mouth open for unconscious/debilitated patient.
				(vii) Foam swabs recommended for patients without teeth.
				(viii) Best description of oral health assessment, defined and described caries, periodontal disease, gingivitis.
				(ix) No mention of using toothpaste to clean dentures, but picture on page 891 shows toothpaste being used. (x) Denture removal and insertion directions simplistic too and incongruent with published dental research.
				(xi) No recommendation to use interdentate sticks or floss heads for flossing.
				(i) The oral health assessment was limited to 3 paragraphs in one health assessment chapter. There was no information on checking dentures for fit, integrity, or plaque. (ii) Provided overall correct mouth care techniques, including tongue brushing.
Taylor et al. [33]	4.75	1742	0.27%	(iii) Gave detailed directions for flossing using string floss; nothing about alternatives.
				(iv) For dependent patient, advised the use of padded tongue depressor to prop mouth open instead of a bite block.
				(v) Advised using toothpaste for dentures.
				(vi) No content on removing dentures from patient’s mouth.
				(vii) Recommended mouth care every 1-2 hours, especially for persons who were not able to take anything by mouth.
				(i) Erroneously instructs patients in “Teaching Your Client About Oral Hygiene” to use regular toothpaste when brushing dentures.
Wilkinson and Leuven [39]	4.5	1089	0.41%	(ii) Also included a recipe for toothpaste, 1 part baking soda, 2 parts salt.
				(iii) Did not recommend removing and leaving dentures out overnight.
				(i) Included 3.3 pages about assessing the oral cavity; one of the most comprehensive.
				(ii) Included the use of foam swabs for mouth care, although the authors stated that toothbrushes better remove plaque and debris.
Wilkinson and Leuven [34]	11.3	1026	1.10%	(iii) Included content on the use of a floss holder.
				(iv) Recommended dilute hydrogen peroxide as a mouth wash.
				(v) Recommended toothpaste for cleaning dentures.
				(vi) Denture removal incongruent with published dental research.(vii) No indication for leaving dentures out overnight.
				(viii) For providing mouth care to an unconscious patient, recommended using a bite block or a padded tongue depressor.