Preparing for surgery involves a precise set of instructions designed to maximize patient safety and minimize complications. One of the most frequently asked questions centers on maintaining personal hygiene, particularly whether a patient can brush their teeth on the day of the procedure. The concern arises because strict rules often prohibit consuming anything by mouth for several hours before anesthesia. Understanding the precise distinction between oral hygiene and breaking the pre-operative fast is crucial for complying with medical directives.
Brushing Safely While Maintaining Fasting Guidelines
The common instruction before surgery is to be NPO, which is a medical abbreviation for Nil Per Os, meaning “nothing by mouth.” This rule is designed to ensure the stomach is empty, preventing the severe risk of pulmonary aspiration during anesthesia. Despite this, brushing your teeth is generally not only permitted but encouraged, provided the patient does not swallow any liquid or toothpaste. The small amount of water involved in brushing does not typically compromise the fasting state unless it is consumed in volume.
The key to safe brushing is to use minimal water and be meticulous about spitting out all residual toothpaste and rinse water. Patients should use a soft-bristled brush and a small amount of paste to gently clean their teeth and gums. The goal is to remove plaque and bacteria from the mouth without introducing any significant volume of fluid into the digestive system. If a patient is uncertain about their ability to avoid swallowing, they should consider dry brushing without toothpaste or simply using a moist gauze pad.
Infection Control and Aspiration Risk
Oral hygiene is a factor in surgical safety that extends beyond the concern of fluid intake. Poor oral health leads to a higher concentration of bacteria in the mouth, particularly in dental plaque. Studies have shown that reducing this bacterial load through consistent pre-operative care can help decrease the risk of post-operative infections. This is relevant for conditions like post-operative pneumonia, which can be caused by the aspiration of bacteria-laden secretions into the lungs.
The risk of pulmonary aspiration is significant during the induction of anesthesia. If the oral cavity contains an excess of fluids, these contents could be refluxed and inadvertently inhaled into the lungs once protective reflexes are suppressed. While the aspiration of stomach contents is the main danger, the aspiration of oral secretions or residual fluid can also lead to severe infectious complications. Therefore, a clean mouth reduces the infectious potential of any material that might be aspirated.
Essential Oral Hygiene Guidance for Surgery Day
Beyond standard brushing, there are specific guidelines for other oral hygiene products and appliances on the day of surgery. Patients who use mouthwash should confirm its use with their medical team, as many formulas contain alcohol, which can dry out the oral tissues. If allowed, alcohol-free mouthwash should be used, and the patient must ensure all the liquid is thoroughly spit out afterward. The small volume of fluid in a rinse must not be swallowed.
Removable dental appliances, such as dentures, retainers, or clear aligners, must be removed before the procedure. These items can become dislodged during anesthesia and pose a serious risk of airway obstruction or damage. For patients experiencing dry mouth, which is common during fasting, they should ask the anesthesiologist about permissible measures. In some cases, a small, sugar-free throat lozenge may be approved to stimulate saliva, but no item should be consumed without explicit permission.