Dysphagia - Halton Region

Dysphagia
Oral Health Care Tips
for
Individuals That Have Difficulty Swallowing
August /08

Mission Statement
Together with the Halton community,
the Health Department works to achieve the best
possible health for all.
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• Swallowing difficulty
Dysphagia Defined
• 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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Tongue
Oral/Facial Implications
• 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
• Malnutrition
• Dehydration
• Aspiration pneumonia
Dysphagia
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Dysphagia and Stroke
• Level of dysphagia
depends 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 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 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 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 “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 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
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