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
Tips for Caregivers:
Liz Molina M.S. CCC-SLP