Oral health in older patients with oropharyngeal dysphagia

Ortega, Omar; Parra, Carlos; Zarcero, Silvia; Nart, José; Sakwińska, Olga; Clavé, Père

doi:10.1093/ageing/aft164

Cited by 84 publications

(67 citation statements)

References 23 publications

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“…As hypothesised, before commencement of the oral hygiene protocol, participants with oropharyngeal dysphagia had worse oral health than their counterparts without dysphagia. This finding is consistent with previous studies which have found that dysphagia, poor oral health and undernutrition are significantly correlated in geriatric populations . Poor bolus clearance, oral residue and poor saliva management related to sensorimotor dysphagia were likely contributors to poorer oral health.…”

Section: Discussionsupporting

confidence: 93%

An oral hygiene protocol improves oral health for patients in inpatient stroke rehabilitation

Murray

Scholten

2017

Gerodontology

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The objective: To determine whether a simple oral hygiene protocol improves the oral health of inpatients in stroke rehabilitation.The background data discussing the present status of the field: Poor oral health can lead to serious complications, such as pneumonia. The comorbidities associated with stroke, such as dysphagia, hemiparesis and cognitive impairment, can further impede independent oral care. International stroke guidelines recommend routine oral care but stop short of detailing specific regimes. Materials and methods:The oral health assessment tool (OHAT) was conducted by speech-language pathologists with 100 patients with and without dysphagia in three metropolitan inpatient stroke rehabilitation facilities. A simple nurse-led oral hygiene regime was then implemented with all participants, which included twice daily tooth brushing and mouth rinsing after lunch, and oral health was measured again one week later.Results: Initially, dysphagia was negatively associated with OHAT scores, and independence for oral hygiene was positively associated with oral health. After one week of a simple oral hygiene regime, the OHAT scores available for 89 participants indicated an improvement on average for all participants. In particular, 59% of participants with dysphagia had an improvement of 1 or more points. None of the participants developed pneumonia. Conclusion:A simple, inexpensive oral hygiene regime resulted in positive outcomes for patients with and without dysphagia in inpatient stroke rehabilitation settings. Oral health assessments and oral hygiene regimes that are simple to implement by the interdisciplinary team can be incorporated into standard stroke care with positive effect. K E Y W O R D Sclinical protocols, deglutition disorders, dysphagia, nursing, oral health, oral hygiene, rehabilitation, stroke

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Section: Discussionsupporting

confidence: 93%

An oral hygiene protocol improves oral health for patients in inpatient stroke rehabilitation

Murray

Scholten

2017

Gerodontology

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“…18 Poor oral health with oropharyngeal bacterial colonization, malnutrition with consequent impaired immune system, and aspiration are the three elements increasing the risk of aspiration pneumonia among elderly patients and those with neurological disease. 67,69 Aspiration pneumonia is the main cause of death in patients with Parkinson disease, amyotrophic lateral sclerosis and several types of dementia. 68 A 10-year review found that the number of hospitalized older patients diagnosed with aspiration pneumonia had increased 93.5% whereas other types of pneumonia had decreased.…”

Section: Complicationsmentioning

confidence: 99%

Dysphagia: current reality and scope of the problem

Clavé

Shaker

2015

Nat Rev Gastroenterol Hepatol

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383

238

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Dysphagia is a symptom of swallowing dysfunction that occurs between the mouth and the stomach. Although oropharyngeal dysphagia is a highly prevalent condition (occurring in up to 50% of elderly people and 50% of patients with neurological conditions) and is associated with aspiration, severe nutritional and respiratory complications and even death, most patients are not diagnosed and do not receive any treatment. By contrast, oesophageal dysphagia is less prevalent and less severe, but with better recognized symptoms caused by diseases affecting the enteric nervous system and/or oesophageal muscular layers. Recognition of the clinical relevance and complications of oesophageal and oropharyngeal dysphagia is growing among health-care professionals in many fields. In addition, the emergence of new methods to screen and assess swallow function at both the oropharynx and oesophagus, and marked advances in understanding the pathophysiology of these conditions, is paving the way for a new era of intensive research and active therapeutic strategies for affected patients. Indeed, a unified field of deglutology is developing, with new professional profiles to cover the needs of all patients with dysphagia in a nonfragmented way.

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“…The oral health of patients with dysphagia is concerning, particularly in elderly patients, because when poor oral health and oral diseases are combined with the presence of swallowing and feeding problems, poor functional status, underlying diseases and an increasing age, the risk of aspiration pneumonia is highest. The importance of maintaining adequate oral health has long been recognised by speech pathologists (SPs), who primarily evaluate the motor and sensory functioning of the oral cavity structures involved in speech and swallowing.…”

Section: Introductionmentioning

confidence: 99%