Post on 21-Jul-2016
Dysphagia
Oral Health Care Tipsfor
Individuals That Have Difficulty Swallowing
August /08
2
Mission Statement
Together with the Halton community,
the Health Department works to achieve the best
possible health for all.
3
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
4
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
5
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
6
Three Health Complications of Dysphagia
• Malnutrition• Dehydration• Aspiration pneumonia
7
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
8
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
9
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
10
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 )
11
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
12
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
13
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.
14
Best Practice for Oral Care
• Ontario Heart and Stroke (2002)
• Langmore (2003)
• Region of Halton (2007 )
15
Oral Health Assessment for the Individual with Dysphagia
16
Oral Health Assessment Tool Validated
17
Oral Care Plan Validated
Oral Care Plan should be updated asMedical, Physical, and Cognitive functions change
18
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
19
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
20
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
21
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
22
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)
23
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
24
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
25
Skill Building
• Take your time • Eliminate noise and distraction
• Ensure upright patient posture• Use mop and go technique
26
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