9g Special Topics in Oral Health - Dysphagia- Oral Heath Care Tips

Dysphagia

Oral Health Care Tipsfor

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• Parkinson’s Disease• Amyotrophic Lateral

Sclerosis (ALS) • Multiple Sclerosis(MS)• Muscular Dystrophy• Huntington’s Disease• Myasthenia Gravis• Alzheimer’s 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 mouthFacial muscles:• Pocketing of food• Cannot close lipsSensation 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 dysphagiadepends on the intensity of the stroke approx.½ 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 don’t 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 don’t 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 agent” to 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 asMedical, Physical, and Cognitive functions change

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Oral Care Planning for Natural Teethand

DenturesCustomize 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 pathologist’s 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 SuppliesNatural 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 “mop” any 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 callHalton Region Health Department at

905-825-6000Toll free: 1-866-4HALTON (1-866-442-5866)

TTY 905-827-9833

www.halton.on.ca