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Oral hygiene recommendations based on dysphagia severity and common speech-language pathology interventions.

Oral hygiene recommendations based on dysphagia severity and common speech-language pathology interventions.

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Oral health is known to be a factor contributing to health related quality of life in the general population. However, it particularly important in the health and outcomes of people with dysphagia, especially those at risk of aspiration. However, despite poor oral hygiene being considered a modifiable risk factor, oral health professional such as S...

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... 2 presents an overview of some considerations that would warrant a flexible, individualised approach to oral care provision. In Table 3, specific adaptations of oral care strategies for different degrees of dysphagia severity are presented. In the sections that follow, specific approaches and techniques to oral care that are suitable and recommended for three groups of patients with dysphagia are discussed: (a) patients receiving texture modified diets; (b) patients with profound dysphagia (or who are nil by mouth), and (c) patients who have sialorrhea (drooling). ...

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... A toothbrush was the most used hygiene aid followed by a gauze soaked in mouthwash. Mouth rinsing is not a safe cleaning method for soft tissues in dysphagic patients; nevertheless, chlorhexidine could be applied in a gel form or with a sponge [39], but, in fact, it was not generally used. Our patients used fluoride toothpaste, which is indicated for tube fed patients, preferably with no foam-inducing agents to reduce the risk of aspiration [39]. ...
... Mouth rinsing is not a safe cleaning method for soft tissues in dysphagic patients; nevertheless, chlorhexidine could be applied in a gel form or with a sponge [39], but, in fact, it was not generally used. Our patients used fluoride toothpaste, which is indicated for tube fed patients, preferably with no foam-inducing agents to reduce the risk of aspiration [39]. ...
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... Hastaların yutma güçlüğüne ilaveten el ve diğer motor becerilerini etkileyen ek hastalıkları, sendromları olması durumunda bu öneriler ebeveynlere anlatılarak; çocuklarının ağız ve diş temizliğinin onlar tarafından yapılması istenmektedir. 51 El manipülasyonu yeterli olmayan, fırçayı iyi kavrayamayan hastalarda elektirikli diş fırçaları yada kalın saplı diş fırçası önerisinde de bulunulabilir. 40 Eğer hasta sıvıları yönetmede oral kontrolü sağlayamıyorsa, tükürme kabiliyeti yeterli değilse köpürmeyen (sodyum lauril sülfatsız (SLS) macun) diş macunu ile fırçalama yapılabilir. ...
... Yemek yeme süreleri artmış, öksürük refleksi az olan ya da koruyucu olamayan hastalarda, aspirasyon riski yüksek ve ileri seviyede disfaji belirtileri gözlenen hastalarda her yemekten sonra ağız içi mutlaka temizlenmelidir. 20,50,51 Aspirasyon pnömonisi gelişimi riskinin azaltılması için de hangi ağız bakım önerilerinin uygulanmasının kesin fayda sağlayacağı net değildir. 52 Ancak yaşlı hastalarda aspirasyon pnömonisini azaltmak için önerilen ağız bakım prosedürlerinin ele alındığı bir derlemede, her yemek sonrası diş fırçalama, protezlerin günde bir kez temizlenmesi ve haftada bir profesyonel ağız bakımının sağlanması önerilmiştir. ...
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Çiğneme, besinlerin transferi ve yutma süreğen olaylardır. Çiğneme fonksiyonu dişlerin, çiğneme kaslarının, temporomandibular eklemin ve dilin, yanakların, dudakların koordineli hareketlerini içerir. Yutma fonksiyonu ise dudaklar, dil, damak, farinks, larinks ve özefagus kaslarının koordine çalışmasını gerektiren, yaygın duyusal motor sinir ağına sahip, dinamik ve karmaşık bir harekettir. Yutma dizisinin herhangi bir aşamasında gerçekleşen bozulma olarak tariflenen disfaji durumunda besin alımının güvenliği, verimliliği veya yeterliliği zarar görebilir. Çoğunlukla disfaji tanı ve tedavisi multidisipliner bir yaklaşım gerektirir. Disfajisi olan hastalar aspirasyon pnömonisi gelişimi açısından büyük risk içindedirler. Bozulmuş bir ağız ve diş sağlığı varlığı ile ortaya çıkan oral kaynaklı enfeksiyonlar, özellikle aspirasyon ve ilişkili enfeksiyonlar için kritiktir. Bu tip enfeksiyonların önüne geçmek için yutma fonksiyon bozukluğu olan hastalar ağız-diş sağlığına önem vermeli, ağız hijyeninin sağlanması için eğitilmelidirler. Bu hastalarda ağız-diş sağlığına yönelik tedavilerin tamamlanması ve iyi bir diş kapanış ilişkisinin sağlanması ile çiğneme fonksiyonuna, dolaylı olarak da yutma problemlerinin giderilmesine katkı sağlanması mümkün olacaktır.
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