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Med-Surg · chapter 19 · Gastrointestinal System and Disorders

Disorders of the Oral Cavity

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.

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Key points

  1. Plaque and caries formation

    Poor dental hygiene allows plaque to break down or demineralize tooth enamel, causing dental caries or cavities.

  2. Caries clinical impact

    Caries may cause pain, make it difficult to chew foods and drink liquids, and can also affect an individual’s self-esteem when the caries are easily visible.

  3. Caries pathophysiology

    These bacteria live in plaque and biofilm on the teeth and convert carbohydrates, such as starches and sugars, into acids (Rathee Sapara, 2023).

  4. Caries risk factors

    Factors that contribute to an increased chance of dental caries include tobacco use, diabetes, high carbohydrate intake (including high amounts of sugar), advanced age, and dry mouth.

  5. Caries manifestations

    A patient may complain of tooth pain or sensitivity when eating foods that are hot, cold, or sweet. Physical signs ultimately include brown, black, or white discoloration or staining of the tooth.

  6. Caries prevention

    Prevention of dental caries starts with brushing teeth two times a day with a fluoride toothpaste and flossing daily.

  7. Inpatient mouth care

    In the inpatient setting, it is important for nurses to provide mouth care for patients who are unable to perform self-care.

  8. Older adult caries risk

    Caries and tooth loss can increase with age because of decreased saliva production, receding gums, chronic disease, and vision, cognitive, and physical limitations.

  9. Oral cancer risk factors

    Although it is unknown what exactly causes the DNA mutations, factors that have been shown to increase the risk of oral cancer include tobacco use, heavy alcohol use, exposure to human papillomavirus, excessive sun exposure to the lips, and a weak immune system.

  10. Nonhealing oral lesion

    Oral cancer is suspected when an oral lesion will not heal and is in place for 2 weeks or longer.

  11. Oral cancer assessment

    When assessing a patient for oral cancer, signs and symptoms to seek include loose teeth, lip or mouth sores that do not heal, white or red patches inside the mouth, lumps (visible in the mouth or palpated around the jaw or neck), pain in the ears or mouth, hoarseness, and difficulty swallowing, chewing, or moving the jaw.

  12. Oral cancer care priorities

    The priorities of care during treatment are maintaining a patent airway and healthy nutritional status, and providing emotional support, pain relief, and patient education.

  13. TMD manifestations

    The patient may present with pain in the jaw area that may radiate to the face, neck, or ears; limited movement or locking of the jaw; clicking or popping when opening or closing the mouth; and a change in bite alignment.

  14. TMD patient teaching

    Teaching should include avoiding eating hard foods, reducing the habit of jaw clenching or gum chewing, application of heat or cold to area, taking NSAIDs, and gently performing stretching exercises of the jaw.

Terms to know

mastication
Digestion begins in the upper gastrointestinal tract at the mouth, where individuals chew food—a process called mastication.
plaque
The term plaque refers to a sticky film on the teeth made up of leftover food particles and bacteria.
cariogenic bacteria
Dental caries are caused by cariogenic bacteria, bacteria that cause tooth decay, in the mouth.
Temporomandibular disorder (TMD)
Temporomandibular disorder (TMD) is a collection of more than 30 disorders that cause pain and dysfunction of jaw movement.
TMJ
The TMJ is a sliding hinge that connects the mandible to the skull.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. At 0900, a nurse observes a mouth lesion. The patient reports that it has not healed for 2 weeks but is not painful. Which documentation and follow-up plan is best?

    1. Document oral cancer based on the lesion's duration; request provider confirmation of the diagnosis.
    2. Document the lesion, its reported duration, and the absence of pain; report the findings to the provider.
    3. Document a painless mouth lesion and provide oral-care teaching; notify the provider if pain develops.
    4. Document the lesion and its duration; reassess at the next visit before deciding whether to report it.

    Answer: Document the lesion, its reported duration, and the absence of pain; report the findings to the provider.

    A lesion that has not healed for 2 weeks raises suspicion for oral cancer even when painless, so the findings should be accurately documented and reported. Waiting for pain or another visit delays the follow-up described in the section. The findings support further evaluation, not documentation of a confirmed cancer diagnosis.

  2. At 1000, a patient reports jaw pain that began earlier this week, occurs daily, and worsens with jaw clenching during stress. The nurse is documenting the history before examining jaw movement or providing teaching. Which entries are supported at this point? Select all that apply.

    1. Jaw pain has improved following stress-management teaching.
    2. Patient reports jaw clenching during stress makes the pain worse.
    3. Assessment confirms temporomandibular disorder caused by stress.
    4. Patient reports jaw pain began earlier this week and occurs daily.
    5. Jaw range of movement is within normal limits.

    Answer: Patient reports jaw clenching during stress makes the pain worse., Patient reports jaw pain began earlier this week and occurs daily.

    The supported entries record the reported onset, frequency, and aggravating factor, which the section identifies as focused assessment information. The other entries infer a confirmed diagnosis, a response to teaching, or an examination result that has not been established.

  3. A patient receiving treatment for oral cancer has the care-plan goal, "By 1800, the patient will report less mouth pain." At 1800, the patient reports no decrease in pain. Which entry best documents the evaluation and next step?

    1. Pain-relief goal not met by the deadline; modify the goal and interventions based on the evaluation.
    2. Pain-relief goal not met; extend the deadline and continue the same interventions without revision.
    3. Pain-relief goal completed because planned nursing interventions were performed; continue routine monitoring.
    4. Pain-relief goal remains pending; defer evaluation until the cancer treatment course is completed.

    Answer: Pain-relief goal not met by the deadline; modify the goal and interventions based on the evaluation.

    The section directs the nurse to evaluate goal achievement by the deadline and modify goals and interventions when the goal is not met. Simply extending the deadline or postponing evaluation leaves the unsuccessful plan unchanged. Completing interventions does not establish that the patient's pain-relief goal was achieved.

Where every quote comes from

Section 19.2 Disorders of the Oral Cavity of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.