Dysphagia
Dental Care
Kathleen Funck
About me
Kathleen Funck, MCD, CCC-SLP
• Who am I?
– Kathleen Funck
• Where did I graduate?
– LSU Health New Orleans 2014
• Where do I work?
– Veterans Affairs Medical Center
• What’s my focus?
– Degenerative Diseases
Agenda
What we will cover today:
✓
1
Welcome
2
Dysphagia
3
Who is involved?
4
Evaluation and Treatment
5
Surprise
Kathleen Funck
Dysphagia
What is it?
•United States Department of Veterans Affairs
Defines it as
- A swallowing disorder
•National Institute on Deafness and Other
Communication Disorders
Defines it as
-having difficulty swallowing and may even
experience pain while swallowing
Kathleen Funck
Etiologies
Strokes
1
Approximately 71 to 73% of patients
with a stroke have swallowing
disorders
Head Injuries
2
51% of patients admitted with
severe hcad injury showed
pharyngeal problems affecting
swallowing
Head and Neck Cancer
3
severity can depend on the tumor
size, staging and location, and the
type of surgical resection and
reconstruction.
No case is the same
and no individual
should be treated the
same. Every case is
unique and different.
Progressive Neurologic Diseases
4
Approximately 300,000 to 600,000
people each year
Kathleen Funck
Terminology
Aspiration
Bolus
entry of secretions, food, or any foreign material into the airway that travels below the level of the true
vocal folds.
the food, liquid, or other material placed in the mouth for ingestion
Degluttion
refers only to acts associated with bolus transfer and transport from the oral cavity to the
stomach
Laryngeal
Penetration
the entry of secretions, food/liquid, or any foreign material into the laryngeal vestibule above the level of the true vocal
folds which are then ejected from the airway. This can occur normally and can also occur before, during, or after the
pharyngeal swallow.
Vallecula
Silent
Aspiration
A channel, or depression between the base of the tongue and the epiglottis
Material breaches vocal folds into trachea and potentially into lungs without any signs
Kathleen Funck
Phases of a Swallow
Oral Phase
1
Oral Preparatory:
reducing food to a bolus
and
position
it
for
transport.
Oral Transport: bolus is
prepared for transport
from the anterior to
posterior oral cavity
Pharyngeal Phase
2
• Velopharyngeal port closes
•
Hyoid bone and larynx
begin ascent
•
Epiglottis folds down
•
Tongue to the posterior
pharyngeal wall
•
Pharyngeal constrictors
•
Cricopharyngeus muscle
•
UES.
Esophageal Phase
3
•
•
UES opens and food
is propelled down
through
the
esophagus
LES opens and food
goes into stomach
Kathleen Funck
Who is involved?
Everyone
Doctors and the
Nursing Staff
Speech,
Physical,
Occupational
Therapy
Dietians, Dental
Care
Family and Friends
Kathleen Funck
Multi-disciplinary Approach
•Speech Language Pathologist
The goal is to maximize the safety and efficiency of
eating.
-Feeding evaluations and treatments
84% in hospitals
90% in residential health care
•Dental Care
The goal is to provide daily dental and denture hygiene
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Symptoms
• Hesitation to swallow
• Painful swallow
• Constant feeling of a
lump in the throat
• Food sticking in the
throat
• Regurgitation
• Hoarse voice
• Repetitive swallowing
• Coughing during or
after swallow
• The feeling having to
“wash down” foods
• Unexpected weight
loss
Kathleen Funck
Evaluations
Bedside
Evaluation
It includes a structural and functional evaluation of the
2
muscles and structures used in swallowing, functional
evaluation of actual swallowing ability, and judgments of
adequacy of airway protection and coordination of respiration
and swallowing
Instrumental
Evaluation
Videofluorscopic swallowing evaluation
(VFSS)
Fberoptic endoscopic evaluation of swallowing
(FEES)
Standardized
Testing
Swallowing Ability and Function Evaluation
(SAFE)
Mann Assessment of Swallowing Ability
(MASA)
Kathleen Funck
Bedside Evaluation
•
•
•
•
•
•
•
•
Past medical history
Current medical status and medications
Nutrition/Hydration
Respiratory status
Cognitive/Communicative history
Posture and Movement
Alertness and Awareness
Auditory and Visual Acuity
•
Oral Motor Exam
• Laryngeal Function
• Respiratory Status
• Trial Swallows
Kathleen Funck
Videofluoroscopic Swallow Study
•
•
•
•
Bolus Size
Texture
Position of Patient
Radiographic focus of the
structures
• More Accurate
Kathleen Funck
VFSS
Videofluoroscopic Swallow Study
VFSS
Videofluoroscopic Swallow Study
Treatment
Supraglottic Swallow
• Take a breath
• Hold it while swallowing
• Then cough after the swallow
1
Supersupraglottic Swallow
same procedure as with the supraglottic swallow, but bear down
while holding breath
2
Postures
3
• Head Down
• Head Back
• Head Turn
• Head Tilt and turn
Mendelsohn Maneuver
4
Turn head to weak side and tilt head to strong side
learns to use muscles to keep the larynx elevated for several seconds after the swallow.
Thermal and Tactile Stimulation
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5
•
•
•
•
Tapping or rubbing of the faucial pillars using frozen q-tips, or lemon ice
Presenting a warm or cold bolus
strong tastes or textures
Pressing the spoon on the tongue when food is presented
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Diets
Level 1: Pureed
Level 2: Mechanical
Altered
Level 4: Regular
Level 3:
Advanced
Kathleen Funck
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Liquids
Thin
Thick
Kathleen Funck
This is placeholder text.
Important?
Patient
Better
quality of life
Professional
Staff
Material aspirated is heavily
colonized with bacteria.
Rapid development of extensive
bacterial colonies around the
teeth will lead to colonization by
respiratory pathogens.
The risk becomes increasingly
prevalent the longer a dependent
patient resides in a health care
environment. All of these patients
are at elevated risk for aspirationrelated pneumonia if not provided
good dental hygiene.
Kathleen Funck
Test your knowledge
True
OR
False
Kathleen Funck
Stroke is the leading cause of
neurologic dysphagia?
True
OR
False
Kathleen Funck
More than 60,000 people die annually
from complications related to
dysphagia, making it the sixth leading
cause of death in the United States?
True
OR
False
Kathleen Funck
Videofluoroscopic examination is
essential and the same assessment
techniques may be used with all
patients with dysphagia?
True
OR
False
Kathleen Funck
THANK YOU!
Contact me at:
kfunck@lsuhsc.edu
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