Nurses are the healthcare professionals most frequently performing health screening during an individual’s admission to the facility. Since the initial screening is meant to reveal the need for immediate attention, nurses must know what findings indicate an urgent concern. A systematic process for dental screening will direct appropriate attention to areas of need.

Subjective

A person’s medical and dental history hold clues to potential dental issues that need attention. The following questions can reveal pertinent background for a complete dental profile.

• Are you currently undergoing a dental procedure or receiving dental treatment?
• Have you been hospitalized recently?
• What medications are you currently taking?
• Do you have any dental concerns?
• Do you have any removable dental appliances such as dentures, partial dentures, or bridges?

Objective

Developing oral assessment skills will help in determining conditions that need a dentist’s attention. Focus on learning what normal looks like. Then, abnormalities and unexpected findings will clearly present themselves.

Lips and buccal mucosa should be pink, soft, moist and smooth. Note any pallor, cyanosis or blistering.

Teeth should be white and smooth. Note any missing teeth, decay or ill-fitting dentures.  The presence of dental appliances and “grills” should be noted.

Gums should be moist and firm without retraction. Note any receding or bleeding gums.  Note any areas of inflammation or infection. 

Tongue should be pink, move freely, and with no tenderness.

Floor of mouth should be smooth and without masses or lesions.

Palate and oropharynx should be pink and smooth. Note any discolorations, swelling, or boney growths.

Special Issues

Trauma: 

Recent mouth trauma might be present due to the circumstances of arrest. Note any lost or broken teeth. In addition, consider fractures of the jaw or other facial structures in your examination. Facial or oral trauma may result in airway obstruction and should be closely monitored and managed by a provider.

Infection: 

Infection is always an area of concern. A significant mouth infection that results in facial swelling, a fever of 100.5 °F (*fever parameters are defined per facility protocol and nurses must be aware of the parameters at their facility) and an elevated pulse over 100 beats-per-minute indicates a need for immediate provider evaluation. If no provider is on-site, then sending to the local hospital should be considered. Localized swelling with fever less than 100.5 °F and no difficulty swallowing can usually be seen by a provider in the next 24 hours.

Oral Cancers: 

The incidence of oral cancers is high among tobacco and alcohol users. Therefore, incarcerated patients are prime candidates for the condition. Mouth lesions should be referred to a dentist if they are red with diffuse borders or are white patches that don’t rub off.  In addition, oral lumps or any complaint of oral numbness should be evaluated by the dentist. Ear pain, hoarseness, and difficulty chewing may also be indications of oral cancer and need provider evaluation.  

Devices: 

Cataloging all tooth equipment on intake is an important nursing function.  This helps validate patient information later in the stay, in case there is an allegation that dental equipment was damaged or lost. Understanding dental terminology will speed documentation and keep communication clear.  Here are some common terms for dental appliances.

• Bridges Dental bridges are made to replace one or more missing teeth and are not removable. Even though they are permanent, bridges and their location should be documented during the intake screening.
• Partials  Unlike bridges, partials are removable and often involve metal work to anchor them in the mouth. They are expensive to create and replace. Patients may have a less-expensive temporary partial, sometimes called a flipper. Temporary partials solve the issue of missing teeth without extensive fitting. Temporary partials have much less metal and crafting. 
• Dentures Solid castings of the full, upper or lower set of teeth are called dentures. Document the type (full, upper, lower) and condition of the dentures during the intake screening.
• Orthodontic Wires Incarcerated patients may arrive at the facility with orthodontic wires. Standard braces are found in the middle of the teeth and are used to straighten teeth. Arch bars are found below the gum line and are placed temporarily for bone healing after facial trauma. Normally, arch bars are removed after 6 – 8 weeks, but we often encounter patients who have not returned for their follow-up appointment to remove them. If there are no complications such as infection, arch bars can remain in the mouth until the patient is released. 

This information is from The Correctional Nurse Educator class entitled Dental Concepts for the Correctional Nurse.

In our next dental blog post, we will discuss common dental conditions seen in correctional healthcare.