Dysphagia

Oral Health Care Tips

for
Individuals That Have Difficulty Swallowing
August /08
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Mission Statement
Together with the Halton community,
the Health Department works to achieve the best
possible health for all.
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Dysphagia Defined
Swallowing difficulty
Not a disease but a series of symptoms
3 types oral, pharyngeal, esophageal
1 in 10 people over the age of 65 have a
swallowing problem
Ontario Heart and Stroke Foundation 2003
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Causes of Dysphagia
Stroke
Spinal Cord Injury
Cerebral Palsy
Parkinsons Disease
Amyotrophic Lateral
Sclerosis (ALS)
Multiple Sclerosis(MS)
Muscular Dystrophy
Huntingtons Disease
Myasthenia Gravis
Alzheimers Disease
Tumours of the head and
neck
Injuries to head and neck
Diabetes
Arthritis
Scleroderma
Chemotherapy
Anatomical abnormalities
Drug induced dry mouth
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Oral/Facial Implications
Tongue
Can not control food during chewing
Can not push food from front to back of mouth
Facial muscles:
Pocketing of food
Cannot close lips
Sensation Loss:
Cannot feel the food in the mouth
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Three Health Complications of
Dysphagia
Malnutrition
Dehydration
Aspiration pneumonia
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Dysphagia and Stroke
Level of dysphagia
depends on the intensity of
the stroke approx.of
individuals will recover
Early detection of
dysphagia improves the
outcomes- lowers the
mortality and pneumonia
rates
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Risk Factors for Individuals with
Dysphagia in Predicting Aspiration
Pneumonia
Dependent for feeding
Multiple medical diagnosis
Current smoker
Tube fed
Dependent for oral care
Number of decayed teeth
Number of medications
Langmore 2003
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Bacterial Pneumonias are Most
Common in Institutionalized
Individuals Because of:
Food, secretions, stomach contents
Sinus infections
Dental decay and periodontal disease, from dental
plaque
Langmore 2003
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Impaired Resistance to Bacteria
Due to Dysphagia
Normal defense mechanisms dont work
Coughing is impaired by intubations or neuro-muscular
problems such as stroke
Immune response is compromised (client is run down
from illness )
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Development of Pneumonia
Pharynx becomes colonized with bacteria that
dont belong there
Aspirates large volumes of bacteria into lungs
Local defense mechanism in lungs are
compromised and cannot resist infection
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Tube Feeding as an Alternative
Results in a high incidence of aspiration
pneumonia
Causes poor esophageal motility
Causes regurgitation of colonized bacteria in the
oral cavity
Due to the lack of saliva there is no buffering
agentto reduce bacteria
The individual that is dependant on a caregiver is
most at risk of pneumonia
Marik- Aspiration Pneumonia and Dysphasia in the Elderly 2003
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Silent Aspiration
40-71% of individuals who aspirate chronically, do so
silently (do not cough or show signs of distress)
Silent aspiration is due to a reduced sensation to the
laryngeal and pharyngeal regions.
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Best Practice for Oral Care
Ontario Heart and Stroke
(2002)
Langmore (2003)
Region of Halton (2007)
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Oral Health Assessment
for the Individual with Dysphagia
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Oral Health Assessment Tool
Validated
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Oral Care Plan
Validated
Oral Care Plan should be updated as
Medical, Physical, and Cognitive functions change
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Oral Care Planning for Natural Teeth
and
Dentures
Customize care for each
individual:
Bed brushing
In a Gerri chair or
wheelchair
An activity in bathroom
sitting on walker
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Care Planning Assessment
Individuals oral status should be
assessed
Their ability to brush their own
teeth may be limited from a
stroke, traumatic head injury, etc.
Check for food pocketing areas
Use speech pathologists notes
for severity of Dysphagia
Establish care plan
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Oral Care Positioning
Sitting or bed position
should be at 90 degrees
Head slightly forward
Chin tucked down
Follow directions of
speech pathologist when
available
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Pocketing of Food
Remove debris with 4x4
gauze or j-cloth that has
been lightly moistened
with warm water
Write down areas of
food pocketing on care
plan
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Daily Care Supplies
Natural Teeth
Hand towel - disposable cloth
4x4 gauze
Non-alcohol fluoridated mouth
wash, Perivex or water
NO toothpaste to be used
2 toothbrushes (large handle)
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Techniques for Providing Oral Care
for Natural Teeth
Lightly moisten brush and
j-cloth or gauze
Remove debris with moist
cloth or gauze then brush
teeth
Continue to use cloth or
gauze to mopany saliva
or debris while brushing
teeth
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Denture Concerns and Care
Bacteria on dentures can be inhaled
by an individual with Dysphagia
Decreased oral muscle function from
Dysphagia puts a person at risk of
swallowing their denture
Dentures must be removed when
sleeping to prevent aspiration
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Skill Building
Take your time
Eliminate noise and
distraction
Ensure upright patient posture
Use mop and go technique
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For more information call
Halton Region Health Department at
905-825-6000
Toll free: 1-866-4HALTON (1-866-442-5866)
TTY 905-827-9833
www.halton.on.ca