Dysphagia, or difficulty swallowing, is a common problem among patients in skilled nursing facilities (SNFs). The ability to swallow is important to patients' oral and physical health, especially because it is a vital part of getting proper nutrition and maintaining good oral health. Swallowing is a simple task for healthy individuals, but when problems occur during this process, it often causes local and systemic medical issues, including dental conditions.
Dr. Alexis Lee.
Dysphagia is unfortunately a very common problem among older adults and people with disabilities because it can be related to dementia, stroke, a brain injury, cerebral palsy, Parkinson’s disease, or multiple sclerosis. These conditions all affect the nervous system, which is vital to effective swallowing.
Patients with dysphagia may have either a cognitive impairment -- due to dementia or other related diseases -- or they have a physical problem, such as a developmental disability, or a condition as a result of a new diagnosis or injury. Younger patients residing in SNFs often have developmental disabilities that affect their ability to swallow.
The main symptoms of dysphagia include coughing or choking during eating and drinking, drooling, difficulty masticating food, regurgitation, heartburn, and hoarse or garbled speech. Over time, these symptoms can cause dehydration, insufficient nutrition, and respiratory infections, including pneumonia. As a result, these symptoms and effects often interfere with proper oral hygiene, leading to dental disease.
Another added complication involves those with a tracheostomy. Studies suggest that as high as 93% of patients with a tracheostomy have dysphagia.
Patients with a tracheostomy often experience a buildup of mucus in their mouths that should be identified and removed to prevent infection and to simply make the patient more comfortable. While many patients with a tracheostomy are typically fed with total parenteral nutrition through a peripherally inserted central catheter, oral health is still very important, because infections and inflammation can occur without the patient taking any food by mouth.
It can be a common misconception that if a person is not using their teeth to eat food, they will not have any oral or dental health problems. However, these patients are still susceptible to oral disease. For example, dry mouth from the tracheostomy and likely polypharmacy leads to an increased caries risk. Additionally, calculus still forms on the teeth from minerals in the saliva and salivary glands.
In receiving dental treatment, patients with dysphagia need more accommodations for successful oral care. To prevent coughing and choking, the patient should sit in an upright position, if possible.
For drooling, ample suction is the most helpful removal method, or if a suction system isn't readily available, have plenty of dry gauze on hand. Although surgery may be indicated for severe dysphagia, less invasive treatment includes specialized physical therapy to strengthen the swallowing muscles and instruction on proper food positioning in the mouth.
Additionally, patients with dysphagia may need smaller and more frequent meals with liquid thickeners added to beverages. Another issue to be aware of is that with an increased number of meals, patients may be more susceptible to food pocketing. The most simple way to relieve food pocketing is for the patient to swish and rinse with water after every meal.
Dr. Alexis Lee is a San Francisco Bay Area native and is a graduate of the University of the Pacific Arthur A. Dugoni School of Dentistry. She also received her Bachelor of Arts degree in rhetoric from the University of California, Berkeley. Since becoming a dentist, Lee has never forgotten her love of reading and writing and is excited to incorporate dentistry on her journey of becoming an established author.
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