Modifying food and drink is only one way of making sure a person with dysphagia stays healthy. Here's a little bit about how important those pearly whites are in the bigger picture 🖼️🦷👅
A huge part of managing dysphagia is about making sure that food and drink doesn’t go down the wrong way when a person is swallowing. Understandably, this is to avoid choking and aspiration but also to avoid a chest infection or aspiration pneumonia. However, what many people don’t realise about dysphagia and oral health is that there is a higher risk of pneumonia if the person has poor oral health, rather than if they aspirate from a healthy mouth. 😬
How I usually break it down to my patients is that there are a lot of different microorganisms in the mouth, and when a person has good oral hygiene, the good microorganisms flourish and keep your mouth pink and moist, and your saliva clear. However, if someone doesn’t maintain their oral care, especially if they are unwell and have a compromised immune system, then the “bad” microorganisms flourish… and Bob’s your uncle. 🦠
Well, Bob’s not really your uncle. It’s not that straight forward. A person can aspirate food or drink with poor oral conditions and be fine but research shows there is a greater risk of infection. If a person aspirates food and drink coated in infected saliva, they’re also at a greater risk of developing pneumonia.
One of the key things that we Speech Pathologists look out for during our assessments is what the tongue and gums look like. There is a thick white coating that can spread through the mouth when a person is unwell, otherwise known as oral thrush or candida. Yes, it’s a fungal yeast infection that thrives when oral hygiene is not up to scratch. This is a key example of when infection-causing microorganisms breed in the mouth.
Some other risk factors that contribute to developing oral conditions can include tobacco smoking, xerostomia (dry mouth), use of antibiotics or corticosteroids, a compromised immune system, and chemo or radiotherapy, amongst some others.
Again, it is not a given that you will develop oral thrush if you have any of these risk factors but it’s always good to keep up your oral care routine to compensate for the risks. Especially because not all of these risk factors are avoidable, such as chemo and radiotherapy.
Mostly for the reasons described, it’s not unusual to develop oral conditions during cancer treatments, especially of the head and neck. During treatment, a person’s immune system is compromised and the cell’s in the mouth can change, making them more susceptible to infection. Oral thrush is one condition but a person can also be more susceptible to mucositis and xerostomia, depending on their treatment regime. A dedicated oral care routine can be a huge game changer when undergoing chemotherapy or radiation therapy.
Xerostomia can occur for a number of reasons but probably most commonly as a side effect to medication. Having a dry mouth can be uncomfortable but more importantly can foster that “bad” bacteria I mentioned, therefore increasing the risk of oral thrush and other undesirable microorganisms. Naturally, a dry mouth can also impact how easily (or not so easily) someone can move food around in their oral cavity to chew, prepare and swallow. So dry mouth has the potential to contribute to the oral stages of dysphagia. This is most commonly seen with dry and sticky foods such as biscuits, bread and pastries. The good news is that, although a dry mouth may not be cured as such, it is very easily treated with over the counter products at the pharmacy that come in a range of modalities such as mouth rinses, sprays, gels and toothpastes.
Reduced saliva management can come in many forms, most noticeably as dribbling or drooling, but less noticeably as saliva trickling into the throat without intention or control and often resulting in coughing or aspiration. This can happen overnight, often due to posture, but also during the day while upright and alert. Unfortunately, this isn’t always something that can be resolved or cured, but is rather managed with strategies or medical procedures. This makes a good oral care routine important to ensure that if any saliva finds its way into the airway, that it is not contaminated with infection-causing microorganisms that can breed in the lungs. The principle is much the same as aspirating food and drink, however the risk of aspirating saliva is not limited to mealtimes and can occur around the clock.
When a person has dysphagia and a characteristic of their swallow is difficulty clearing the mouth of food or oral residue, it can increase the risk of “bad” bacteria. In fact, this is the case for everyone. If food is left in the mouth after eating and not adequately cleared with the tongue, with a sip of drink or by rinsing the mouth, then the food accumulates and breeds bacteria that is not healthy for the mouth’s environment. Especially in dysphagia, the residue is sometimes not sensed and so an additional strategy to check or clear out the mouth is required.
So, given all of this, what constitutes good oral care?
Brush your teeth twice a day with toothpaste.
Make sure you gently brush your gums, tongue and roof of mouth as well.
Rinse your mouth thoroughly.
Floss your teeth daily.
Rinse your mouth after meals.
Change your toothbrush every 3-4 months (every season).
Visit your dentist regularly.
You might also consider a tongue scraper and mouthwash if you’re wanting to be extra thorough.
While we’re all about being creative in the kitchen, sometimes we have to do some work in the background to make sure we’re staying healthy and happy, and so we can continue to enjoy all the good things food has to offer.
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