A Case Report of Ultrasonic Scaling in a Hospital Ward Bed with Oral Care Gel Instead of Water Irrigation

Abstract

　Introduction:　In patients with dysphagia, oral hygiene management is important because the oral environment tends to deteriorate by oral hypofunction and less self-cleaning. Oral hygiene management, including scaling (dental tartar removal) in patients with dysphagia, should be performed by a safe method while preventing the risk of aspiration. In this case report, we describe a patient with dysphagia and orthostatic hypotension who underwent tartar removal using an ultrasonic scaler with oral moisturizing gel as an alternative to water injection to prevent aspiration and hypotension.

　Case:　A 55-year-old male. He had cerebellar hemorrhage after brain tumor resection and postoperative bulbar palsy, which caused dysphagia and orthostatic hypotension. He was admitted to our hospital for surgery to improve swallowing function. Evaluation of the oral cavity revealed significant accumulation of dental tartar.

　Course:　Although ultrasonic scalers can efficiently remove tartar, there is concern about the risk of aspiration due to the influx of water into the pharynx. Therefore, we attempted to remove tartar in a sitting position, but a marked decrease in blood pressure was observed for a short period of time, which was thought to be due to orthostatic hypotension. The sitting position is desirable for dysphagia, while the supine position is desirable for orthostatic hypotension: the two positions are contradictory. We attempted to remove tartar using an ultrasonic scaler while the patient was in bed, without water injection, using an oral moisturizing gel. Vital signs were monitored and pain was assessed during the procedure. No abnormalities in vital signs were observed during all procedures, and there were no complaints of pain during or after the procedures. The removal of tartar was as effective as when the ultrasonic scaler was used under water injection, and it was possible to prepare the oral environment before surgery.

　Discussion:　Tartar removal using oral moisturizing gel instead of water made it possible to remove tartar while the patient was in bed, while preventing aspiration and hypotension. Oral care gel may be useful for tartar removal to avoid aspiration and hypotension.