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Dental Care

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:.

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Dental Care

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  1. Dysphagia Dental Care Kathleen Funck

  2. 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

  3. Agenda What we will cover today: Welcome ✓ 1 Dysphagia 2 3 Who is involved? 4 Evaluation and Treatment 5 Surprise Kathleen Funck

  4. 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

  5. Etiologies Strokes 1 Approximately 71 to 73% of patients with a stroke have swallowing disorders 4 No case is the same and no individual should be treated the same. Every case is unique and different. Head Injuries 51% of patients admitted with severe hcadinjury showed pharyngeal problems affecting swallowing 2 Head and Neck Cancer severity can depend on the tumor size, staging and location, and the type of surgical resection and reconstruction. 3 Progressive Neurologic Diseases Approximately 300,000 to 600,000 people each year Kathleen Funck

  6. Terminology entry of secretions, food, or any foreign material into the airway that travels below the level of the true vocal folds. Aspiration the food, liquid, or other material placed in the mouth for ingestion Bolus refers only to acts associated with bolus transfer and transport from the oral cavity to the stomach 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. Degluttion Laryngeal Penetration A channel, or depression between the base of the tongue and the epiglottis Vallecula • Material breaches vocal folds into trachea and potentially into lungs without any signs Silent Aspiration Kathleen Funck

  7. Phases of a Swallow Oral Phase Pharyngeal Phase Esophageal Phase 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 • Velopharyngealport closes • Hyoid bone and larynx begin ascent • Epiglottis folds down • Tongue to the posterior pharyngeal wall • Pharyngeal constrictors • Cricopharyngeus muscle • UES. • UES opens and food is propelled down through the esophagus • LES opens and food goes into stomach 3 2 1 Kathleen Funck

  8. Who is involved? Everyone Doctors and the Nursing Staff Speech, Physical, Occupational Therapy Family and Friends Dietians, Dental Care Kathleen Funck

  9. 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 Your Logo

  10. 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

  11. Evaluations 2 It includes a structural and functional evaluation of the 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 Bedside Evaluation Videofluorscopicswallowing evaluation (VFSS) Fberopticendoscopic evaluation of swallowing (FEES) Instrumental Evaluation Swallowing Ability and Function Evaluation (SAFE) Mann Assessment of Swallowing Ability (MASA) Standardized Testing Kathleen Funck

  12. 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

  13. Videofluoroscopic Swallow Study • Bolus Size • Texture • Position of Patient • Radiographic focus of the structures • More Accurate Kathleen Funck

  14. VFSS Videofluoroscopic Swallow Study

  15. VFSS Videofluoroscopic Swallow Study

  16. Treatment Mendelsohn Maneuver Supraglottic Swallow 2 • 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. • Take a breath • Hold it while swallowing • Then cough after the swallow 3 1 4 Supersupraglottic Swallow Thermal and Tactile Stimulation • 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 • same procedure as with the supraglottic swallow, but bear down while holding breath Postures • Head Down • Head Back • Head Turn • Head Tilt and turn Your own footer Your Logo 5

  17. Diets Level 1: Pureed Level 4: Regular Level 3: Advanced Level 2: Mechanical Altered This is placeholder text. Kathleen Funck

  18. Liquids Thin Thick This is placeholder text. Kathleen Funck

  19. Important? 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 aspiration-related pneumonia if not provided good dental hygiene. Kathleen Funck

  20. Test your knowledge OR Kathleen Funck

  21. Stroke is the leading cause of neurologic dysphagia? OR Kathleen Funck

  22. More than 60,000 people die annually from complications related to dysphagia, making it the sixth leading cause of death in the United States? OR Kathleen Funck

  23. Videofluoroscopic examination is essential and the same assessment techniques may be used with all patients with dysphagia? OR Kathleen Funck

  24. THANK YOU! Contact me at: kfunck@lsuhsc.edu Your Logo

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