The 7 Steps Of Oral Care for Dysphagia

Oral care is a vital part of the adult speech therapy job. And if you’re an SLP working with dysphagia, you’ll likely encounter it every day.

In this article, you’ll learn all about oral care, including:

• Why it’s so important
• The 7 steps of oral care for dysphagia

What Is The Purpose of Oral Care?

The purpose of oral care is to help keep your patients safer and healthier.

Research shows that proper oral care decreases the incidence of aspiration pneumonia in patients across multiple healthcare settings (Fields, 2008; Hua et al., 2016; Juthani-Mehta et al., 2013; Watando et al., 2004).

Intensive oral care may also reduce the incidence of pneumonia by improving cough reflex sensitivity (Watando et al., 2004).

Oral care can also:

• Reduce bacteria in the mouth and pharynx
• Improve oral intake (by improving oral sensation, dry mouth, and salivary flow)
• Decease malnutrition
• Prevent tooth decay
• Improve breath!

(Chen et al, 2019)

7 Steps Of Oral Care For Dysphagia

Help your patients with dysphagia establish a proper oral care regimen.

Most patients should perform oral care at least twice daily, morning and night. Some may also need oral care before and/or after oral intake to avoid bacteria entering the airway.

Encourage visits to the dentist every 6 months for cleaning and check-ups.

As needed, treat xerostomia and consider a mouthwash to reduce bacteria.

Here are the 7 steps to perfoming oral care:

1. Gather your supplies. Supplies you may need:
   • Disposable gloves
   • Toothbrush with soft bristles
   • Toothpaste
   • Oral swabs (Toothette®)
   • Water
   • Clean cups
   • Tongue depressor
   • Penlight
   • A small basin
   • Floss or interdental brush
   • Suction (if severe dysphagia and unable to manage secretions)
2. Position the patient as upright as possible
   • Some patients may also benefit from leaning forward over a basin to allow water, toothpaste, and saliva to drain out
3. Have good lighting. Keep a penlight or flashlight handy
4. Brush/Swab. See the American Dental Association’s recommendations on how to brush teeth
   • When possible, have the patient brush/swab their own mouth
   • Clean all surfaces of the teeth, inside the cheeks, along the gum lines, the palate, on top of and under the tongue
   • Remove dentures to clean the gums and palate. Properly clean dentures.
   • Assist if they can’t complete independently
5. Check with a light
   • Periodically check to ensure they/you are removing as much debris, buildup, and/or dried secretions as possible
6. Have patients spit
   • If using toothpaste, have the patient spit into the basin/sink after brushing
7. Use floss or interdental brush

Video: How To Complete Oral Care

In this video, speech-language pathologist Alisha Kleindel demonstrates how to do oral care for dysphagia, including what to do if your patient is NPO.

More Dysphagia Resources

Visit our shop for print-and-go dysphagia assessment templates, handouts, and treatment guides.

For more help, see our course for clinicians new to adult speech therapy.

References

• Chen, H. J., Chen, J. L., Chen, C. Y., Lee, M., Chang, W. H., & Huang, T. T. (2019). Effect of an Oral Health Programme on Oral Health, Oral Intake, and Nutrition in Patients with Stroke and Dysphagia in Taiwan: A Randomised Controlled Trial. International journal of environmental research and public health, 16(12), 2228. https://doi.org/10.3390/ijerph16122228
• Fields L. B. (2008). Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit. The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses, 40(5), 291–298. https://doi.org/10.1097/01376517-200810000-00007
• Hua, F., Xie, H., Worthington, H. V., Furness, S., Zhang, Q., & Li, C. (2016). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. The Cochrane database of systematic reviews, 10(10), CD008367. https://doi.org/10.1002/14651858.CD008367.pub3
• Watando, A., Ebihara, S., Ebihara, T., Okazaki, T., Takahashi, H., Asada, M., & Sasaki, H. (2004). Daily oral care and cough reflex sensitivity in elderly nursing home patients. Chest, 126(4), 1066–1070. https://doi.org/10.1378/chest.126.4.1066