Oral Stimulation

With some patients, even though they are awake and even alert, they are not responding to oral instructions such as "open your mouth," etc.

You can use a dry or moistened toothette to stimulate oral opening by stroking the lower and/or upper lips. You may be able to gently enter the mouth with the toothette along the inner cheek or along the gumlines. It may even be possible to stroke the tongue blade. As you perform these actions, watch your patient to determine tolerance, sensation, and any responses.

To further provide oral stimulation, you may also use the spoon to stroke the lips or the area of the cheek or chin around the lips. Before placing a food item in the mouth, you may want to put a little on the lower lip to see if the patient will lick it off indicating sensation is relatively intact. You have also determined that the tongue will protrude at least a little.

If the patient does not close around the spoon with presentation of liquids, pouring the liquid (very small amount) onto the tongue tip may then elicit lip closure. Be prepared to suction this liquid from the mouth if the patient does not handle well.

Applying pressure with the bowl of the spoon to the tongue blade may also assist in the cupping of the tongue for oral preparation. Letting go of the spoon also may assist the patient to close his or her mouth around the spoon -- appears to be a typical response to this technique.

Just some thoughts...