Dentures and Dysphagia

When your dysphagia patient doesn't have his dentures
You walk into a patients room to perform a beside swallow exam. While you go through your questions your patient mentions that he has dentures but they're at home. What do you do?
You perform the exam regardless!
Your job is to assess your patients current swallowing ability. If he doesn't have his dentures that's fine, you assess how he eats without them. For a lot of denture wearers not having their dentures is NOT a problem. I've seen a man who lost his dentures eat an entire steak without difficulty...it just took him a while to do it! During the examination if you see the patient is having difficulty masticating and maybe he was hospitalized for shortness of breath, then being on a regular diet without his dentures is probably not functional. You can put him on a temporary downgrade to puree while he is recovering and re-assess him as his health improves or his dentures are located.

When your dysphagia patient has his dentures!
So your patient was lucky and had his dentures with him when he was hospitalized or placed in a nursing home! If your patient has dysphagia though, his dentures may not necessarily be helpful. A study by Son, Seong, Kim, Chee, and Hwang, "The Effects of Removable Denture on Swallowing" looked at swallow function with individuals who wore dentures. Under a videofluoroscopic swallowing study they compared the patients ability to swallow with and without their dentures.  The study results showed that without their dentures oral transit time was reduced and oropharyngeal swallow efficiency increased. They concluded that a removable denture might have negative effects on swallowing ability possibly caused by impaired sensation of the oral cavity or masticatory performance induced by the dentures. Dentures or implants can reduce sensation in the oral cavity, and sensory input (i.e. taste) plays an important role in normal control of voluntary swallow. Improper denture wearing also increases swallowing difficulties by causing changes in tongue movements. The instability of dentures should be considered when looking at swallow function. If a denture is too big it or ill fitting it causes jaw instability and extraneous tongue movement to keep the denture in place. While attempting to control a bolus during mastication, this can become effortful for a patient. Denture adhesive also needs to be taken into consideration. Some denture adhesive might not affix the denture well which can cause jaw instability and extraneous tongue movement. Some denture adhesive can cause desensitization and impact sensory function. It is important to take all of these facts into consideration when performing a bedside swallow exam on a patient with dentures.

Tips to tell your patients
Eating with Dentures

• Don't bite with your front teeth 
• Chew on both sides of your mouth simultaneously to increase stability of dentures
• Cut food into small pieces and place them on both sides at the same time
• Avoid sticky foods, raw vegetables, and hard to chew meats until you become more comfortable with your dentures
• Dentures decrease sensory input so be careful with hot foods or anything with small bones in it 

Living with Dentures

• Try speaking slowly at first, practice reading aloud. Speaking is a different experience when wearing dentures
• You might have increased saliva due to decreased sensory input, be aware of the saliva build up and swallow the saliva don't spit it out. Spitting out saliva can cause more saliva to build.
• When you sneeze, yawn, or cough your dentures can loosen
• You need to remove your dentures at least once daily for a period of time to rest the tissue below them
• After you've been wearing your dentures for years your jaw becomes smaller from wear and normal recession and your dentures don't fit as well. Slippage, gum irritation, and odor are signs that this is happening and you need to get your dentures re-fitted.

Tips for Caregivers:

• When you take dentures out don't wrap them in tissues or napkins. This often leads to them unintentionally being thrown out
• Dentures don't have to be maintained wet. You don't have to put them in a cup of water or container with water. Once out of the mouth they can be kept dry. The acrylic they're made out of will not be altered.
• Simplest way to clean a denture is with a soft toothbrush, a little liquid soap, and a lot of water afterwards to rinse off the soap.
• Whenever you handle a denture do it over a sink or over a towel. A lot of people break dentures when handling them by dropping them on the ground.
• Before placing the denture back in the mouth, it's more comfortable for the patient if it's wet not dry
• Most denture adhesives work best when the tissue side of the denture is dry
• One of the best ways to heal a denture sore is with warm salt water. However if the patient has high blood pressure they have to be monitored carefully if they swallow it as salt can raise blood pressure.
• Lastly, NEVER try to repair a broken denture with super glue. First, super glue is toxic, second it makes it harder for a dental technician to fix it afterwards once you've placed super glue on the denture

More Info on Dysphagia