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