Mouth care advice for people experiencing swallowing difficulties

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Mouth care advice for people experiencing swallowing difficulties
Mouth care advice for people
experiencing swallowing
difficulties after stroke
Delivering the best in care
UHB is a no smoking Trust
To see all of our current patient information leaflets please visit
www.uhb.nhs.uk/patient-information-leaflets.htm
This leaflet has been designed to support the family and carers of
those who have swallowing difficulties (‘dysphagia’) and who require
assistance with mouth care following a stroke.
Speech and Language Therapists (SLTs) work with people who are
experiencing problems with their communication but we also provide
assessment and advice to those experiencing swallowing difficulties
and who sometimes require specialist advice with mouth care.
Why do we need good mouth care?
Mouth care is important for everybody. A clean,
comfortable mouth is essential for good physical
health and general quality of life. Unclean mouths
lead to development of plaque and debris on the
teeth and gums. This may increase the risk of tooth
decay and may cause serious infections elsewhere in
the body.
People who have swallowing difficulties are at
increased risk of inhaling (aspirating) these bacteria
into the lungs. This may lead to an increased risk
of chest infections or other serious respiratory
difficulties.
What can you do to help?
There are many reasons why keeping
your own mouth clean after a stroke is
more difficult; people may have muscle
weakness (hemiparesis), impaired vision,
and problems with memory and/or
communication.
You can help by:
• Checking their mouth is clear before and after eating or drinking –
residue may ‘pocket’ in the sides of the mouth
• Prompting them to clean their mouth and asking if they would like
help
• Supporting them to clean their mouth
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What does mouth care involve?
A high standard of mouth care should
be maintained in people with difficulty
swallowing, and particularly in those who
are nil by mouth (NBM). Please seek advice
from a member of nursing staff before
commencing oral care – it should involve the following:
• Regular brushing of teeth, gums and tongue – aim to do this at
least twice a day
• Making sure that you explain what you will be doing. You may
wish to use objects, gesture or simple words to help explain what
the mouth care will involve
• Try standing behind and slightly to one side of the person so that
you can access the mouth more easily
• Try tilting the head slightly forward to reduce the risk of inhaling
the toothpaste and/or residue from their teeth/mouth
• If the individual is unable to sit fully upright, a different position
may be used. This may include laying them on their side with their
head on a pillow (please consult a member of nursing staff about
this)
Dry mouth
People who have difficulty swallowing, and particularly those who
are NBM can experience a dry mouth (xerostomia). Saliva is important
for helping to keep the mouth clean and to protect the body from
bacteria. Signs of dry mouth can include:
• Dryness of the soft tissue that lines the mouth (mucosa)
• An absence of saliva
• Frothy appearance to the saliva
• Thick ‘stringy’ saliva
• Cracked and dry lips
Image by Brocken Inaglory (Own work) [CC BY–SA 3]
PI_1720_Mouth care advice for people experiencing swallowing difficulties after stroke | 3
Dry mouth can be associated with a number of factors:
• Facial paralysis or weakness
• Side effects of medication
• ‘Mouth breathing’ (i.e. people who sleep with their mouths open
or keep their mouths open when at rest)
• Mouth suctioning
• Use of oxygen
Good mouth care can help to keep the mouth moist. Please discuss
management of dry mouth with an SLT who can recommend suitable
strategies and products. The Doctor may be able to prescribe an
artificial saliva spray or gel to help relieve symptoms.
Other factors to consider:
• Remember that people who are NBM or
who suffer from dry mouth can develop
an aversion or ‘sensory defensiveness’
(negative reaction) to having their teeth
and gums brushed. You may notice that
they flinch, grimace or cover their mouths.
Please discuss this with an SLT for further
advice.
• Similarly, following a stroke, patients may experience altered
sensations in their mouth. This can be helped by very gradually
increased amounts of regular oral care with a soft brush and
suitable toothpaste.
• Consideration of sugar free/low sugar versions of liquid medication
and/or dietary supplements where possible.
• Consideration of specialist products to keep
the mouth clean where needed. If the person
is NBM it may be appropriate to use soluble
(dissolvable) toothpaste such as the Biotene
products (please ask ward staff if they are
able to obtain these products for you).
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• Consider using pineapple or mango juice which contains an
enzyme that helps to break down bacteria and to thin thick/sticky
saliva. If you relative is nil by mouth (NBM) they will not be able
to drink fruit juices so please discuss this with the Speech and
Language Therapist – you may be able to administer pineapple
juice on a moist toothbrush.
Ask a Speech and Language Therapist for further advice:
Contact the Speech and Language Therapy team during normal
working hours (8.30am – 4.30pm) on 0121 3713483.
For general information and advice or any concerns:
Contact the Patient Advice and Liaison Service (PALS)
on 0121 371 3280
Further Advice:
Stroke Association Helpline: 0303 3033 100
Website: stroke.org.uk
Email: [email protected]
References and acknowledgements:
Oral Hygiene Guidelines, UHB Policies, UHB NHS Foundation Trust
Guidelines for the oral health care of stroke survivors
www.gerodontology.com/content/uploads/2014/10/stroke_guidelines.pdf
Oxleas NHS – Jenny Bruce (Lead Dental Therapist) & Lesley Brown (Senior Specialist
Speech and Language Therapist)
PI_1720_Mouth care advice for people experiencing swallowing difficulties after stroke | 5
Please use the space below to write down any questions you may
have and bring this with you to your next appointment.
6 | PI_1720_Mouth care advice for people experiencing swallowing difficulties after stroke
Please use the space below to write down any questions you may
have and bring this with you to your next appointment.
PI_1720_Mouth care advice for people experiencing swallowing difficulties after stroke | 7
The Trust provides free monthly health talks on a
variety of medical conditions and treatments. For more
information visit www.uhb.nhs.uk/health-talks.htm or
call 0121 371 4323.
SPEECH AND LANGUAGE THERAPY
Queen Elizabeth Hospital Birmingham
Mindelsohn Way, Edgbaston
Birmingham B15 2GW
Telephone: 0121 627 2000
PI15/1720/01 Author: Briony Storey, Lizzie Davies
Date: March 2016 Review date: March 2018

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