This text is a transcript of the webinar, Sensory Changes in Adults: Impact on Swallowing and Diet Selection; Part 2, presented by Denise Dougherty, MA, SLP.
Learning Objectives
As a result of this Continuing Education Activity, readers will be able to:
- identify changes in dentition and mastication that occur with aging.
- describe the impact of aging on the sense of taste.
- identify three potential problems with texture-modified meals.
Introduction and Overview
This is Part 2 of a two-part series looking at sensory changes. These are changes that you need to keep in mind when selecting diets and planning therapy programs for your patients.
As far as disclosures, I am receiving an honorarium from SpeechPathology.com, and I make my living as a private practitioner. I am a sole proprietor. As far as non-financial disclosures, I am on the committee that deals with medication review for Quality Insights of Pennsylvania.
What we are trying to emphasize in these two sessions is the fact that aging and disease processes change the swallow, and that, in turn, impacts the nutrition and hydration of our patients. So, this two-part seminar is going to cover the normal aging swallow, physiological changes in the aging patient, and the impact on the swallow, diet and nutrition. In Part 1 we covered a number of different changes that happen with the normal aging swallow, and we will touch on a few of those again today.
Dentition and Mastication
As our patients go through the aging process, it is very difficult to separate what happens with chewing and with dentition; they go hand in hand. As the dentition begins to change, we also see problems with the strength of our patients' chewing.
Reasons for Floppy Dentures
Our patients often have floppy teeth. When we see floppy dentition, there are three issues that could be causing the problem. Usually it is a combination of all three, rather than just one.
Weight loss. The first thing that we need to consider when we see floppy dentures is that the patient has had weight loss. The first area of the body where you see weight loss is in the gums. That is going to impact the fit of the dentures. A person can go into ICU on Monday and have dentures that fit very, very well, and within two or three days they are starting to flop because of lost weight. You have to be very careful whenever there is weight loss and floppy dentures because now there are going to be sores on the hard palate and the gums. That is going to create a painful chewing process for patients. They usually do not want to put the dentures in at that point. That puts us in a difficult position for identifying the diet that is most appropriate for them. If the dentures are beginning to flop because of weight loss, we need to figure out how to get the dentures secured. Are we going to use denture adhesive? Are we going to have them realigned? There are different ways that we could address that problem.
Dry mouth. The second thing that creates a problem with floppy teeth, in addition to or instead of weight loss, is dry mouth. Dentures sit on saliva to adhere to the gums. If the person doesn’t have any saliva - whether that is due to medication issues, or a disease process, or a combination of both - the dentures are going to become very floppy. As I said previously, that will cause sore gums, pressure sores, or even lacerations of the mucosa. The person’s tongue tends to stick to the palate. It is just a very dry environment. This creates another problem because a dry mouth is a breeding ground for bacteria. This makes mouth care even more critical than it would be in a healthy individual. So, not only might we have to use denture adhesive, or have the dentures realigned, but we may also need to address the dry mouth.
One of the things that we talked about in Part 1 is that if you have dry mouth and are not producing saliva, which is often see in older patients or cancer patients, that is going to create a problem in the esophagus. There is a process called esophageal acid clearance, and saliva is needed to wash the acid back down the esophagus. If there is not have enough saliva, then the pepsin - the acid that comes out of the stomach – is more likely to irritate the mucosal lining, and that can create Barrett's Esophagus, and some other problems as well. So, we really need to look at the dry mouth.
