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[0:16] Hi everyone. It's Eva and Emily. And you're listening to Speech Talk. Speech Talk. We're your research book club so that you can stay informed and do evidence-based practice in practice. So let's get talking. Let's talk about dentures. Emily, I have a pop quiz question for you. Did you know roughly 90 to 30 percent of adults over the age of 75 use dentures? I did know that. You naturally start losing your teeth around the age of 65. I know. In addition to incontinence, we also have losing our teeth to look forwards to. So because 19 to 30 percent of people over the age of 75 use dentures and we're losing teeth naturally by the age of 65, we thought that looking at a dentureless people or people who wear dentures was a good place to start for our considerations for oral dysphagia. So we examined two articles for our discussion.

[1:16] Both of them were published by the National Institute of Health. The first is titled The Effects of Removable Dentures on Swallowing by Doxic Sun et al. The other was Futura and Yamashita titled Oral Health and Swallowing Problems. All right, so let's get into it. Here's some of the main takeaways. One, patients who wore dentures regularly outperformed patients in eating trials who inconsistently wore their dentures. So what does that mean? If you get more practice wearing your dentures, you'll be better at using them. So what are some things we can take away with that. We can keep this in mind for assessments and treatment sessions. If they're not wearing their dentures, then we're not going to force them to wear their dentures or provide extra encouragement for them to use their dentures. But let's look at them how they would perform. If they're always having them out, let's look at how they're eating with them out. If they put them in for meals, let's do a trial. See how it is and talk with them through it. Maybe they don't notice that they're chewing differently with their dentures out and in. It's just something that we're able to spot. Yeah, definitely.

[2:33] Do their dentures fit properly? I had this patient who she wore dentures and I was like, I had seen her with them in, you know, she's smiling that like extra white straight smile that is the classic sign of dentures and she wasn't wearing them. And I was like, all right, we're going to do a bedside swallow. Why don't you pop those dentures in? She's like, I've been eating crispy fried chicken since like 2010. I'm not going to put in my dentures for this. I was like, watched her eat a steak, basically just gums, all gums. I was so impressed. and that's how they get to they're just like no care in the world they're just like gnawing away, i've seen someone without their dentures they'll put in like a piece of a huge chunk of pork start chewing on it take it out look at it in their hands and be like i think i could still do it.

[3:25] Pop that sucker back in for time number two yeah they're like we're the visual cues we're almost there. You know what I really like about that is I'm always asking people to open their mouths so like I can assess the amount of like mastication on bolus, like how ground up have they made it with their gums. I like that. They're like, I'm gonna take the initiative. Let me, one moment, spit this out. The way that my toddler does when she doesn't like something, she just takes it out of her mouth and hands it to me. It's like, you know what? I could like do a little more with that. So do they fit properly? In both of the studies, the research stated that poor fitting dentures are a contributing factor to swaddling impairments. We see that in a lot of different ways, that, you know, the dentures aren't fitting. So Emily and I joke that they're like click-clacking around. So if your patient's dentures don't fit and when they're trying to eat, their dentures are literally moving around in their mouths, of course, they're not gonna be able to chew their food well. It's gonna end up chunky. They're trying to swallow chunky food while coordinating moving dentures. It's not a pretty sight. So sometimes realizing that even though they have dentures and they like using their dentures, if it's a poor fit, we can provide some education on maybe using glue, trying to get a refit by a dentist, you know, just trying to get in there and work with them on it. Also, if their dentures don't fit, that may be the reason they're not wearing them.

[4:47] I had a patient with Parkinson's who, even though she was like, oh yeah, I definitely eat better with my dentures and she wasn't wearing them because she was like, right now it's harder. She lost a lot of weight. And so her dentures over the past couple of months had stopped fitting as well. So she was just trying to do it with her gums, but her gums weren't as strong and she was more susceptible to crunchy and uncomfortable textures. So that was also contributing to her weight loss because she wasn't eating her normal food and when you know asked about it she was just like yeah I can't eat as much it's uncomfortable for me to eat it was just like a classic dentures being the underlying problem for weight loss in her case I know and it's so funny however like whenever we start we catch these patients and like uh send them to speech and the solution's always like what did we did we even talk to this patient. Like, I feel like this is such an easy thing. Like, yeah, it's she's had these dentures for 12 years and they don't fit right. They're getting, she's getting sores in her mouth. She.

[5:54] Not really an oral dysphagia. Like this is a denture problem. Get her new dentures and then we'll see if there's still a problem. Yeah. And I really like that you said that about the sores. Definitely the friction of poor fitting dentures can create sores and you're like, oh, why aren't you eating? It's like, well, I've got a bunch of like bleeding raw spots in my mouth. It's not exactly easy to chew right now. Yeah. And those lesions, they can come from wearing your dentures too long. So if you're not taking care of them, right, if they're leaving them in your mouth overnight, then that can contribute extra wear on your gums too. And then the next day you're not able to wear them. So then you get this cyclical thing happening. Yeah. And just, again, I love everything you're saying. And that's so big for our dementia patients, right? They don't have the schedule awareness, the nighttime, daytime awareness sometimes, and they are not responsible for their own hygiene schedule. So we really got to be working with our team members for that oral care, you know, making sure that the dentures are cleaned, they are, you know, contributing to additional bacteria or just growing disgusting gunk in our patients' mouths, but also leaving them in overnight. That overuse, just like you're saying, that is its own problem. So Eva, how do you check if dentures are fitting okay? I love that you asked me because I figured this one out from you.

[7:21] Always asking, but to double checking, because as we know, some of our patients are not the best historians. And so I like to, if the dentures are appropriately placed, just grab them, grab the top ones by my pointer finger, my thumb, just pinch them and give them a little wiggle, see if they pop out, see if they move around. Good fitting dentures with glue should not just easily pop out of your mouth, not your mouth, out of your patient's mouth, gross. But one thing I did learn from my mom, because my mom is a dentist, is that the bottom ones don't always pass that test. And that's because it doesn't have the same surface area to promote seal. So that's a great test for the top ones. The bottom ones can be a little harder. Yeah, we'll just look at them.

[8:10] Look okay. And before we forget, I do want to make sure that when we're thinking about poor fitting dentures and stuff getting built in you, because you got those patients who their dentures don't fit well, and they're just like sneaking food into the top of the dentures and into like the depression where the gum should fit in. You're just like get ground beef and vegetables and gross stuff packed in there. And that's like a huge aspiration risk. So it's not just gross, which it 100% is. It's also about making sure that we're not creating delayed aspiration risks as food comes out of the dentures throughout the day and there may be coughing on that, but also that it's growing bacteria in their mouths. And as we know, once that becomes an aspiration risk, we are now also promoting a pneumonia risk because this isn't just food material anymore. It is like bacteria-laden food going into the airway. So particularly for folks who have decreased like oral awareness or just attention to food tasks and body sensory difficulties, making sure they understand how to get food out of their dentures is super important. Yeah, I wish I could say that's been a thing that's happened a few times, but more times than I would like to count. I've taken out dentures from people's mouth and found just a layer of whatever food, scrambled eggs, sausage, all of the food just.

[9:40] Coating the top of the dentures. And it's not something I think about typically whenever I'm in a session, but I'll notice like we're at the end of the meal. And then, then just like out of nowhere, I noticed they start chewing. I'm like, where did that come from? And then it's like, oh yeah.

[9:55] Oh yeah. Remember this article. And so, and it just, it pops into my head, like their, their dentures might not fit. And I pop them out and I'm like, yeah. And then I'll take my plate of my top plate my new food plate to all my aids and i say so and so is not not safe with their dentures we are removing dentures for the time being, do not let them eat with these in i i gross out my team yeah i love bringing, semi-masticated stuff to other people on stuff because people are always like oh we're all care of non-born. I'm always the person harassing people about oral care or dentures and denture maintenance. And I don't know, people don't seem to take it seriously. And then I start bringing them chunks of semi-chewed up food that got stuck in their dentures. Like, oh God, that's brutal thing. We'll start looking into that. It's apparently the gross factor is a good motivating force. Yeah. And their visceral face is always my favorite part. They're like.

[11:03] Love that that's great i wish i could have that be my like text alert sound oh that would be a good okay let's let's move on a little bit the article titled the effects of removable dentures looked at specific swallow measures with dentures and here's what they found so dentures improve patient's ability to grind food so what does that mean.

[11:27] Dentures act like teeth. They help you grind food down. So like we were discussing earlier, for folks with ill-fitting dentures, sometimes food gets too chunky because their dentures aren't fitting well. And so they're like, oh, it's uncomfortable to chew. I'm just going to swallow what's in my mouth.

[11:46] We may have patients who are unable to get food ground down with their gums. And so we may advocate for dentures. You may say, hey, look, at baseline, even though you prefer not wearing them, you're not really grinding down your food. If they're like Emily's patient who's like spitting out pork and it turns out it's still chunky every time they spit it out, maybe we can ask them if they would feel comfortable wearing their dentures more often during meals. I don't know, again, we're not forcing people to wear dentures, but if they're not aware of the potential benefits or they, you know, are trying to weigh whether the comfort versus the practicality is, you know, something for them, maybe we can like do some practice trials with their dentures to see if it's improving how well they can grind their food down.

[12:34] Yeah. And I think it's important to remember that dentures are new learning. So it's learning something new with chewing. Or also decreasing the overall sensitivity in your mouth right so this is a new learning too you have to you're you're eating differently so with dentures removing the sensitivity it's going to mess up the timing of your swallow it's going to mess up the your awareness of residue and your awareness in general so we have to make sure that if the dentures are new if this is something that we're just trying out, they have perfectly fitting dentures, but the sensitivity is down. So it feels weird when they chew and swallow.

[13:16] Practicing with them, doing those trainings and doing sensitivity trainings is important. Dude, a hundred percent. I had this woman who did not need dentures. She had teeth. A little bit irrelevant, but her oral sensitivity was so bad. She just had food in her mouth and she just stopped chewing. And I was like, you got food in your mouth? She's like, no, I don't. And it would open her mouth and like eggs are falling out. And I was like, I don't know how to teach this one. Like it was really hard to be like, where's your tongue? Show me your tongue. Where is the food on your tongue? Can you feel the food on your tongue? It was like, oh my God, I cannot imagine adding dentures into that situation if she had needed them. You know, if she was needed a partial or was a denture on top, I really think she would have been a bad candidate for dentures because she already had no idea what was happening in her mouth. What did you do for her for sensitivity?

[14:08] Um, we did some biofeedback. I cannot find a handheld mirror to save my life at work, But sometimes if they have a phone, I'll use their camera or I'll use, you know, turn the camera around on mine so they can see themselves. They're like, open your mouth. Guess what? Are there eggs in there? Yes, yes, ma'am, there are. You know, so even if they can't feel it, there are other opportunities to sense food. You can also just put your finger in your mouth and be like, do you feel the entire piece of broccoli in there? I think that one's a little more dangerous because they could like potentially push food backwards. I haven't had that problem. But, so usually I just go with the camera or a mirror if I can find one. Can't see me. I'm nodding. I know. The video-audio divide. We give each other lots of thumbs up, by the way, for the fact that you guys can only hear us. We're also doing lots of thumbs ups.

[15:05] Breaking forth walls is fun. Collaboration and monitoring our patients is super important. We want to make sure that we're looking out for our patients and we're looking for trends such as their weight loss and their intake. I mean, these are important factors to consider when we're thinking about their swallowing difficulties related to their dentures. So if we've had someone on caseload and they had dentures and they were doing really good with them, and then all of a sudden we notice that their weight is taking, talk to the nutritionist and the aides, and they say, well, they're not really eating. And then, you know, having that collaboration for them so we understand where we're going back for these patients is important. Maybe they lost their dentures and we're coming to the aides and like, well, I've never seen their dentures. So it's important to make sure we're talking to the team and making sure that we're addressing the concerns and staying up to date on where our patients are and where they continue to go, even after our direct treatment's over. Where I'm at, we have point-click care or PCC, and I'll check some of the people.

[16:17] And I'm not sure if it's because I'm nosy or concerned, but I'll go through some of my old patients just to see. I'll check their weight. I'm just curious to see if I discharge them and we'll come back. And I'll check their weight to see. And it's either flagged or something in red. And then that'll spark me to be like, hey, is this person doing okay? Or I'll go and I'll make sure whatever patient I'm dealing with has a meal in the same dining room as my other person. And just to keep eyes, just to keep talking to people about it. Because it's important to, I mean, in my sniff setting, it's easier. It's probably not as acceptable to other patients. And Eva, you're across two buildings, so that might be harder for you too.

[17:03] Well, one, I think it can be both. I think you can be nosy and concerned for the care of your patients. I don't understand why that mutually doesn't work. I think we can be nosy and want to know. But I think it's really important. Like I will sometimes stop by my patients rooms after they've been discharged, just like see how things are going. Because a lot of times we have to discontinue care because they're out of therapy sessions. That's it. Like they don't have anything more covered or they met their goals, but they have dementia and they have a tendency to regress on things that have been taught. So I always think it's worthwhile to like check in, keep an eye on folks. And to the point of making sure that you're checking weight trends, I always like text our dietician like, hey, weight's OK? Because she's always looking at that data.

[17:56] That's a good way for like people you don't know, too, who can pop up on radar that you haven't even you haven't seen yet either. I'm like, do you know this person? No. Cool. Yeah. Take a look. And I think, I mean, this is something I just continuously cannot get over at, you know, medical settings is how important relationships with CNAs are. Because when you first started a building and you're asking the CNAs how much they ate, they're like, everything was fine, everything was fine. And then you really start getting to know people and working with them. You collaborate on patients. You're like, how's their meals? And they're like, well, actually, I've been finding a lot of food spit out on the side. or, you know, several times this week and last week, they ate, you know, less than 25% of their plate.

[18:40] And so we can't see every meal for everybody. And just making sure that we have those relationships with the folks who are more on the floor with our patients than we are is so key. Yeah. And bringing it back to like, denture-specific patients, whenever we have the dentist come in, if we have this extraction, I'm immediately asking for that list. Like, I want to see those people. I'm advocating for those people to get a sick tray on that day because sometimes there's not anybody who's communicating from the dentist to the dietary manager about who has eight teeth pulled in a single day, you know? Is that a number you've seen? That's crazy. Yeah. It's like the teeth are a bad bat and they're like we're just we're getting them all out and then it's it's a lot so then yeah and i'm like you give this man i don't care about his nutritional intake for the next three days i expect him to have ice cream on every single one of his trays because that was traumatic and i would want that so we're doing that even if it's not just so that he can have tasty purees he deserves ice cream he deserves all the ice cream i remember when i got my braces in That was the first thing my dad got was a milkshake for me. But like the sucking hurt my teeth so bad that I couldn't even eat the milkshake. And I remember just laying there like, oh, I wish I could eat. So I like that is my mental. Whenever someone's a dentist comes in, I say, you give me this list.

[20:10] I need the extraction list. And I need whoever's getting their dentures, too. Like of their brand new dentures, like those people are coming on caseload, too. Dang thinking everybody has bonded to this day i i never know when our dentist is in the building i gotta get on that calendar i gotta get on that calendar at work i'm inspired you inspire me emily no i don't they i so team collaboration they have not told me when the people are coming in however when he comes in i immediately i run to my dor and i'm like you need i need you to drop like four people off my list today because i make these rounds like this is this is important for of the building. And they've always been cool. To advocating for your patients. Again, you inspire me. I love it. I bet my buildings don't feel the same way. They're like, get this speech there. She's too many people. She's just running her own shit. Get her out. For real. Okay, but all dentist jokes aside, it is really important for us to make sure that we can advocate that our patients have access to dentists.

[21:19] Because... oral pain is a contributing factor to oral pharyngeal dysphagia. And if somebody is just consistently having difficulty, then like they should see the dentist and including for our indentulous patients, because if they get oral sores, they may need topical or like oral medication. So it's important to make sure that the right people are getting notified. Yeah, it is. I do love the dentist. I'm just kidding.

[21:50] I love the dentist. She's my mom. So let's do a quick summary. Today's research looked at the significant connections between dentures, chewing, and swallowing. And amongst all the jokes that may have been hidden, but guess what? Those are highly correlated features. So even though dentures can offer a bunch of benefits like improved mastication, the ability to grind food, a proper fit is super important, and consistent usage is important if people want to be using it for eating. As SLPs, we can always play a vital role by incorporating our denture considerations into our evaluations. We can educate our patients on the pros and cons, and we can advocate for proper dental care with other people in our building. And on that note, we made something for you. just for you.

[22:44] We made a handout so you don't have to make one yourself. Our handout, it has, it's kind of like an evaluation addendum. So it has things that you can interview your patients about. It's like, do you wear it for meals? Is it a top? Is it a partial? You know, do you use denture glue consistently? So you can answer those. And then when it's done, it not only informs you, But you can use it as an in-service, like a patient-based in-service for other nursing staff. So you can show the CNAs, hey, this is how the patient is using their dentures. Or, hey, we can use this as a way to advocate for getting the dentist in here because, look, they're not using their dentures, even though they're supposed to be using them for meals because of oral lesions. So things like that. So we hope you like it. And thank you for listening to Speech Talk. See you next time.

[23:42] You've been listening to Speech Talk. Thank you everyone for coming to listen to our research book club. Until next time, keep learning and leading with research. If you like this episode and you want to give us some love, please rate us on your favorite podcasting app. Leave a review and tell the world. Because as podcasters, our love language is in positive affirmations. If you have a research topic you want us to cover, or you have episode comments, clinical experience you want to share, or just want to send us some love letters, Send us an email at hello at speech talk pod dot com. If you want even more speech talk content, check out our website at speech talk pod dot com, where you can find all of our resources we made for you. Copies of articles covered and Eva's blog following these topics and more. We're your hosts, Eva Johnson and Emily Brady. Our editor and engineer is Andrew Sims. Our music is by Omar Benzvi. Our executive producers are Erin Corney, Rob Goldman, and Shanti Brooke. To learn about Speech Talk's program disclaimer and ethics policy, verification and licensing terms, and HIPAA release terms, you can go to speechtalkpod.com slash disclaimers. Speech Talk is a proud member of the Human Content Podcast Network.

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