Oral care and dysphagia
Oral care practices are at the forefront of dysphagia management, and for good reason! Research continues to show that poor oral care is a predictor of aspiration pneumonia (respiratory illness) in people with dysphagia (Juthani-Mehta, et al., 2013). Aspiration pneumonia can occur when bad oral bacteria is breathed into the lungs, or when food, drink or secretions that contain bad oral bacteria are aspirated (swallowed into the lungs rather than down the oesophagus). Those who lie flat in a bed and older people with reduced consciousness are more likely to aspirate oral secretions. Not to mention the impact of poor oral health on taste, reduced appetite, pain, wellbeing, and overall health.
So where to from here? There are lots of strategies you can use to keep your oral health in good shape. And the evidence supports this, as many oral health problems can be avoided with routine preventive care (Lui, et al., 2018).
Here are a handful of care practices and tools that I use with my clients:
Oral health assessment tool
This ones for practitioners (nursing, dental, medical and speech pathologists). Screen your client’s oral health status. Protocols such as the ‘Oral Health Assessment Tool’ are quick and easy to administer, and provide a valid way to investigate the client’s oral health and identify those that are at higher risk of complications (Chalmers et al., 2005).
Website link: https://www.nice.org.uk/guidance/ng48/resources/oral-health-assessment-tool-pdf-2543183533
Regular dental check-ups
Your dentist is your best friend when managing oral health in dysphagia. They can provide a thorough clean, clearing plague, and demonstrating effective practices to yourself and your caregivers to support thorough oral care practices within your home. Keep these check-ups occurring regularly.
Strategies for dental check-ups:
During dental appointments it can be helpful to let your dentist know of certain strategies that may help you throughout the appointment, such as:
Keeping the chair tilted slightly upright to make swallowing during the consult easier.
Request for a dental nurse to be present to assist with suctioning saliva and secretions during the dental examination.
Water flow adjustment during teeth cleaning.
Special needs dentistry:
Some dentists have completed further study to become Special Needs Dentists. Having an increased understanding of the disability sector can allow for smoother treatment, with the removal of barriers to assist in better health outcomes for people with disabilities. Some examples of Special Needs Dentists include:
Dry Mouth Care
Dry mouth, also known as xerostomia, is a common side effect of many conditions. The cause of dry mouth is different from person to person. Some causes include an open mouth posture, medication side effects, dehydration, infections, diabetes, reduced production of saliva from nerve damage, or cancer related treatments (such as radiotherapy or chemotherapy).
Strategies for dry mouth:
When navigating dry mouth, always consult your medical practitioner who can investigate the potential cause, and determine the most effective treatment or management options. A good start with managing dry mouth is simple modifications to your daily intake:
Consider increasing your fluid/water intake - stay hydrated
Reduce your intake of alcohol, caffeine, and smoking
Limit your intake of acidic and sugary drinks
Eat a variety of nutritious wholefoods to support your immunity and overall health
Some other tools to assist in dry mouth care can be found below:
Slippery Elm (available in tea, capsules or mints)
A natural alternative which leaves a coating on the tongue, mouth, and throat, to help keep moisture locked in. Also useful in people experiencing chronic cough symptoms.
Website example:
https://iherb.co/1xAobRMk
Dry mouth gel and mouse
Can be applied around the oral cavity for instant relief up of fry mouth, up to 4 hours. GC Oral Gels are sugar free and aim to maintain a neutral pH balance in the mouth.
Website example: https://www.thehouseofmouth.com.au/brand/gc/
Oracoat xylimelts
Xylimelts adhere to your teeth or gums to relieve persistent dry mouth. The melts slowly release xylitol (a natural sweetener) to stimulate saliva production and protect the gums.
Website example: https://www.thehouseofmouth.com.au/product/oracoat-xylimelts-dry-mouth-stick-on-melts-40pk-mint-free-3/
Dry mouth sprays
Sprays can provide a convenient option for instant relief from dry mouth, and last up to 4 hours.
Website example:
https://www.biotene.com/dry-mouth-products/
Lip balms
A great way to ensure lips remain hydrated is to apply a gentle lip balm after each mouth clean. This will alleviate any discomfort from dry lips.
Website example: https://dermaltherapy.com.au/product/lip-balm-original/
Oral Care Routine
When completing oral care, there are a few strategies involved to ensure a clean is thorough.
Cleaning the mouth
Apply gentle pressure, moving the toothbrush in a circular motion. Remember to clean all surfaces of the teeth, gums, and tongue. Complete this at a minimum morning and night.
Use a soft bristle toothbrush with a high fluoride toothpaste.
For some people with dysphagia, it is important to check for any oral residue after having food or drink. Additional oral care is encouraged after a meal, particularly if there is any food left in the mouth. To do this, using a soft bristle toothbrush (not oral swabs) complete a gentle sweep of the cheeks and roof of mouth to ensure all food residue is cleared. Then if needed, repeat the circular motions of the teeth, gums, and tongue.
Using interdental brushes to gently floss between teeth,
Apply a lip balm.
Take a look at the Educational Tool by SA Dental Service for more information, and great tips on oral care with dentures.
Oral health care plan
For those requiring caregiver assistance for oral care, it is beneficial to have an ‘Oral Health Care Plan’ in place. This is a document that outlines the person’s needs for routine care. It includes information such as:
How often oral care is required
What tools are used
Environmental and communication strategies
When the last dental check-up occurred, and when the next appointment is due
An example oral health care plan:
https://everysmile.dhsv.org.au/__data/assets/word_doc/0010/194194/Oral-health-care-plan-template.docx
Oral Care Tools
Surround three-sided toothbrush
A handy three-sided toothbrush which allows for each tooth to be surrounded by soft bristles to clear plague and build up. For those that don’t tolerate long oral care routines, this also makes for a quicker clean.
Website example: https://mobilemedical.com.au/surround-toothbrush/
Floss and interdental brushes
Easy to use tools that allow for more effective removal of plague and debris that the toothbrush cannot reach.
Website example: https://www.smileboosters.com.au/
Tongue scraper
Handy to clear the tongue of mucosa or thick secretions. Great to include into your regular mouth care routine morning and night.
Website example:
https://iherb.co/wtXGSYaA
Suctioning
Useful for people who are struggling with thick mucous or secretions. A suction machine allows for you to remove the secretions from the mouth using a ‘vacuum’ system.
Website example: https://www.medisupplies.com.au/homecare-suction-unit/
Electric suction toothbrush
Similar concept to the suction machine, but this time paired with a toothbrush to allow for secretion management while brushing.
Website example: https://www.gienic.com.au/electric-suction-toothbrush-system/
Please note that Simply Modified is not sponsored by any of these products. These product listings come from personal and clinical experience within client’s homes, hospital settings, aged care facilities, and private practice clinics. If you have any additional strategies or tools that assist with oral care, we would love to hear from you. Reach out via our Contact Page.
While every effort was made to ensure that the information provided is accurate, it is not intended as a substitute for professional medical advice. Each reader is encouraged to work with their consulting speech pathologist, dentist, and medical team regarding the assessment, possible treatment, and management of oral care in dysphagia.
Additional resources
Your Dental Health Guide: Created by Inclusion Melbourne, this is a wonderful tool for people with disability. The website also includes various forms for oral health care assessments and plans, and some easy to follow videos to assist in effective cleaning.
Teeth.org: A website created by the Australian Dental Association to provide up-to-date resources about oral care, featuring a variety of videos and handy factsheets.
Dentists and Disability: A blog post put together by IDEAS, which lists some useful strategies for oral care, and describes the benefit of Special Needs Dentistry.
References
Chalmers, J. M., King, P. L., Spencer, A. J., Wright, F. A., & Carter, K. D. (2005). The oral health assessment tool--validity and reliability. Australian dental journal, 50(3), 191–199. https://doi.org/10.1111/j.1834-7819.2005.tb00360.x
Juthani-Mehta, M., De Rekeneire, N., Allore, H., Chen, S., O'Leary, J. R., Bauer, D. C., Harris, T. B., Newman, A. B., Yende, S., Weyant, R. J., Kritchevsky, S., Quagliarello, V., & Health ABC Study (2013). Modifiable risk factors for pneumonia requiring hospitalization of community-dwelling older adults: the Health, Aging, and Body Composition Study. Journal of the American Geriatrics Society, 61(7), 1111–1118. https://doi.org/10.1111/jgs.12325
Liu, C., Cao, Y., Lin, J., Ng, L., Needleman, I., Walsh, T., & Li, C. (2018). Oral care measures for preventing nursing home-acquired pneumonia. The Cochrane database of systematic reviews, 9(9), CD012416. https://doi.org/10.1002/14651858.CD012416.pub2
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Written by Brie Simons
Speech Pathologist
