Nurses are the healthcare professionals most frequently performing health screening during intake and booking. 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 potential concern.

 

Subjective

A person’s medical and dental history holds 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, bridges or grills?

 

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 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 or ill-fitting dentures, or areas of decay
• Gums should be moist and firm without retraction. Note any receding or bleeding gums
• Tongue should be pink, move freely, and without 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 the 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/managed.

Infection: Infection is always an area of concern. A significant mouth infection that results in facial swelling, temperature greater than 101 °F or an elevated pulse over 100 beats per minute indicates a need for immediate provider attention. Localized swelling with fever less than 100 °F and no difficulty swallowing can 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, many of our patients are prime candidates for the condition. Mouth lesions should be referred to a dentist when they are red with diffuse borders, white patches that don’t rub off, or a lump or numbness. In addition, hoarseness and difficulty chewing or swallowing can be indications of oral cancer.

Devices: Taking inventory of dentures, partial plates and other tooth appliances on intake is an important nursing function.  This will validate a legitimate need for the item, as well as ensuring that the incarcerated individual is discharged with all of their dental equipment.

What have you discovered about dental assessment as a correctional nurse? Share your experiences in the comments section of this post.