Common oral problems in dysphagic patients and older people
Assessment of the patient’s dental and oral hygiene status is necessary during the clinical examination, after instrumental investigation with boluses and swallowing rehabilitation training. If necessary, appropriate treatment such as dental treatment and oral hygiene care is carried out.
Missing teeth and poorly fitted dentures predispose the patient to aspiration because these conditions often exhibit chewing difficulty which consequently leads the poor coordination with the bolus formation , transportation, and swallowing. Infected teeth and poor oral hygiene predispose the patient to aspiration of contaminated oral secretions , leading to pneumonia . Although tube-fed patients do not feed orally, many studies have shown that feeding tubes do not prevent aspiration of contaminated oral secretions , refluxed enteral foods, or regurgitated gastric contents. One research group evaluated 19 observational cohort studies with respect to the correlation between the duration of feeding tube placement and the proportion of patients free of aspiration pneumonia and found that a nothing per os status provided no protection against aspiration pneumonia .
Therefore, to prevent aspiration pneumonia , clinicians must consider oral hygiene care and how to prevent aspiration in patients who do not feed orally. Additionally, patients with impairments of oral function such as those with hemiparalyzed oral structures (e.g., lips , tongue, soft palate ) experience poor mastication , poor bolus formation , and accumulation of oral residue, all of which increase the risk of aspiration and poor swallowing outcomes.
At FHUR, dentists and dental hygienists play a major role in oral hygiene and dental care. The oral care protocol at FHUR was developed by dentists , dental hygienists , and certified nurses in dysphagia in cooperating with nursing staff in other disciplines, particularly the neurology unit, geriatric unit, pulmonary unit, and otolaryngology head and neck cancer unit (Fig. 6.2).
Oral care protocol at Fujita Health University Rehabilitation Complex
Additionally, the Japanese version of the Oral Health Assessment Tool is utilized for dental and oral health screening. This tool includes eight categories: lips , tongue, gums and tissues, saliva , natural teeth , dentures , oral cleanliness, and dental pain. The score for each category is divided into three levels: 0 = healthy, 1 = oral changes, and 2 = unhealthy. These scores are summed to obtain the total score, the maximum of which is 16 (Fig. 6.3).
Oral Health Assessment Tool (OHAT) for dental and oral health assessment screening
The oral care screening is mostly performed by ward nurses . Patients with a high Oral Health Assessment Tool score, poor dentition , a poor oral status, or the need for further examination and intensive oral care are referred to the dental department. Dentists then individually examine, treat, and prescribe oral hygiene care that is carried out by a dental hygienist .
The oral care protocol involves mechanical cleaning and elimination of contaminants. This is achieved through the following steps (also shown in Fig. 6.4):
Oral moisturizing gel is first applied to the lips and then to the soft surfaces of the oral cavity to moisturize and soften any dried or hard secretions .
The teeth are manually brushed without a dentifrice; an interdental brush is used if necessary.
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