Where Are My Teeth?

[0:00] Music.

[0:15] Hi, everyone. It's Eva and Emily. And you're listening to Speech Talk.

[0:21] We're so close to being in sync on that. We're your research book club so you can stay informed and do evidence-based practice in practice. So let's get talking. All right, fellow SLPs and anyone else who really wants to listen to us. We do a lot of looking in people's mouths and looking at teeth, but how about those fake teeth for our edentulous folks? Those are important too today we're going to be getting into dentures and their impact on swallowing in our episode titled where's my teeth emily why don't you tell us why we called it that, because i think it's funny that people often lose their teeth the amount of times i've heard where my date it's like literally does anyone actually know where their dentures are no found them in a coat pocket once. A coat pocket. There's just like empty denture cups just about. One time I actually found three sets of dentures in one little recept. I was like, which are the right ones? She said, none.

[1:26] Why are we collecting dentures at this point? And you have to just always be fighting that tide of dentures floating back to the kitchen on trays unobserved. Constant. At least their name tag or their names are normally on their trays with their ticket. That's true. That's true. Saving grace. But hopefully today we want to look at a link between aging and tooth loss and their dysphagia, how dentures could potentially influence mastication and swallow patterns, and the crucial role of proper denture fit in safe swallowing. Hey, Emily. Hey, Eva. Did you know roughly 19 to 30 percent of adults over the age of 75 use dentures? Eva, I did not know that. That's a lie. You read the research. You know that.

[2:17] But stick around for more fun facts like that, y'all. So let's get into our research review. Tune in every week to hear Emily and I try and say things together. We're going to look at some research articles. And before we get into the research on dentures, we just want to prime a little bit with some whole patient perspective. When we're working with our patients, it is so important to consider their denture status. Do they have them? Do they wear them regularly? Do they take them out to eat? Do they only wear them socially?

[2:50] How are our patients using their dentures? Because that really informs how we want to be looking at it. If they don't use their dentures when they eat, they shouldn't be wearing them during our eval, you know? Yeah. And aside from eating, dentures provide additional support for articulation and increased confidence for socialization. Being able to initiate those conversations if you're feeling better about yourself just comes from being able to have a wonderful smile. Yeah, some people feel confident with that gummy smile. Some people don't. It's person-dependent. We have looked at two articles for this discussion, both of which were published by the National Institute of Health. The first one is titled, The Effects of Removable Dentures on Swallowing by Diasik Sun et al. The authors' research conducted trials to measure the following. They looked at… They looked at functional dysphagia scales, including oral transit time, OTT, or pharyngeal transit time, PTT. They also looked at percentage of oral residue, the percentage of pharyngeal residue, oral pharyngeal swallow efficiency, and the presence of aspiration were measured. Yeah, they looked at a lot of stuff.

[4:07] And patients performed a range of oral tasks, which measured physical impact of mastication on food. So they gave people a little bit of bolus and they said, chew this down. And they tried to measure increase in surface area. So people who were able to grind food down more were able to increase the surface area of the bolus. They looked at sensitivity of the mouth to bolus, which they did not do with food. They stuck tiny pincers in people's mouths. They're like, not sharp pincers. But they were still pincers. And they would put them at a minimum of like two millimeter difference. And would essentially poke people in the hard palate gently at different sizes between each pincere. And be like, can you feel that this is in two spots? And some people said yes. And some people said no, depending on the amount of space between the pincers.

[4:58] And they looked at the transit of food posteriorly. So, you know, they just gave folks a dysphagia diet level one with some barium mixed in it, and they took a look at that puppy on its way down. So their findings, they showed that when wearing dentures, participants were able to grind food down more effectively, but their oral sensitivity was decreased. And that's super important, right? Like the teeth do help. Having dentures in helps you grind food. But having those dentures in covers such a huge part of your hard palate. So you can't feel what is being blocked. And part of starting that swallow and initiating that swallow is being able to feel when it's ready. So, based on their results, oral transit delays and decreases in oral pharyngeal swallow efficiency were related to masticatory performance or sensation in the oral cavity due to denture wearing. I love those hard phrases like masticatory performance. It's like say that 10 times fast. Masticatory performance, masticatory performance, masticatory. Red leather, yellow leather. It's the new patica. It's the new, oh my God, yes, it's the new patica. Yeah. So what does that really mean for research? Just that the safety and efficiency had mixed results. Like all research, it wasn't entirely conclusive.

[6:19] Some people did better with their dentures in, some people did better with their dentures out. It was really patient dependent. Who's surprised? I will say probably one of my critiques of this research article is I think they did use like a lot of causal language where they're like, because of this, we saw that. And I didn't feel comfortable reporting some of that because that's not how research works. It's not like a perfectly causal nature. We can say correlation, but we can't say causality. Go back to Research 101. This isn't ever a hundred percent that you don't know.

[6:53] Could always be something else. So, now we're shifting gears. We're going to explore a study by Putra and Yamashita titled Oral Health and Swallowing Problems. So, this research takes a closer look at various categories of tooth loss ranging from minimal to complete edentralism, so the absence of teeth. Complete. Just gone. Nothing. Nothing there. A little squeak if you rub it.

[7:22] So the study compared participants who do and do not wear dentures. The research suggests that individuals who wear their dentures consistently experience significantly fewer instances of pharyngeal dysphagia compared to their denture-free counterparts. So let's get into education on this part. Emily, jump in with some knowledge. Knowledge is power, ma'am. We gotta helping the patients understand the link between their dentures and swallowing can be hugely beneficial. So we need to be advocating for dentist visits to ensure proper denture fit so it can improve swallowing safety. Also educating them on how to keep them clean and educating them on like if they feel safer without their dentures. If they feel like being able to feel the food in their mouth feel safer to them than respecting them and in that choice not to wear their dentures.

[8:17] Absolutely. And I love that part of education. I think that it's really easy to skip over when we're trying to do bedside swallow. Just like, all right, got to get in there, got to see what's going on. But really taking the time to say, hey, this is how your dentures can affect your swallowing and your chewing and making sure they understand because that creates buy-in. So whether they want to eat with their dentures in or their dentures out, making sure they understand the potential pros and cons of either is really important. And that education doesn't stop with the patient. Definitely have those conversations with your staff, letting them know that just because Sally doesn't have any teeth doesn't mean she can't chew. No dentures do not automatically need oral dysphagia. Oh, my God. I love that. Yes, I love going in to see an edentulous patient. And I'm like, so tell me what you like to eat. And they're like, give me a hamburger, a steak, fried food. And I'm like, that's, you know, no discomfort, nothing poking your gums, making it hard to chew. And they're like, nope, haven't had teeth for 20 years. You give me that fried, battered, whatever it is, I want it. That's always the thing. It's like, I haven't had dentures in 30 years. Like, okay, ma'am, I believe you.

[9:40] You do you. Or I love it when folks are like only have like a few teeth and they're like, well, I only have a few teeth. I can't, I can't chew it. I'm like, well, the lady two doors down has no teeth and she is just going to town on like hard carrots. Who would have guessed? Okay. So going back to our research, this article highlighted the importance of proper denture fit. They actually had read the original research article we were reviewing and they said that one of their criticisms of it was hey we need to be doing a little bit more assessment of proper denture fit.

[10:18] So ill-fitting dentures can prolong swallow time and increase the risk of aspiration. I see this all the time at work where somebody I go in the room and somebody's like I'm gonna wear my dentures for lunch and then their The dentures are just like click clacking around in their mouth. I'm like, it's like you're trying to swallow two different meals at the same time. Like put some glue on it. Do whatever it is, you know, or take them out. If they cannot properly fit, maybe it is time to try to assess eating without the dentures. And kind of coaching them through, hey, we're actually increasing safety concerns when you have your dentures moving around like that. I know you prefer them, but hey, have you ever considered that maybe that's why you keep gasping on your food all the time?

[11:05] And like sometimes too, food isn't always the answer. I have seen somebody get like so frustrated. They hear their.

[11:13] They start to notice their teeth are moving around in their mouth so they pop them out and it's just, heart caked so much glue is on there and they're just adding more glue on top of that so it's not going to be helpful for not having those proper denture fit conversations with those proper feeding denture conversations we have to set you up with a schedule let's get our dentures ready in the morning, soak them overnight, brush them really well, and then little dots of blue to make sure they're being put on the right way. Follow the instructions. Absolutely. And I think you bring up a really good point that in particular for our folks with limited mobility, for our people with cognitive decline, denture maintenance is really a team task. It really, we need buy-in from CNAs, from nursing, from occupational therapy. Everyone needs to be on the denture train because for some of our folks.

[12:15] Doing that maintenance work is not something that they can do alone. They either don't have the cognitive bandwidth to have a schedule. You know, that's something you can also target as a cognitive goal, right? They were maintaining a daily schedule, have a checklist if they can perform checklist tasks. If it's a mobility issue, get in there with your occupational or physical therapy teammates and say, what can we do to make sure that they are more independent with their dentures? What accommodations can we make?

[12:45] Because like Emily was talking about with built-up glue, we've all seen built-up food. We've all seen that unknown white substance film growing across the top. It's gross. Oh, man. And we all know that oral bacteria leads to risk of aspiration pneumonia or increases the risk of it if aspiration occurs. So that denture cleanliness is such an important safety concern. A big part of our time is reducing re-hospitalization and other larger health risks. And it all starts with your teeth. Brush them, just like mom said. But actually my mom, because my mom said that.

[13:28] We will definitely have them on for an episode or two. Yes.

[13:33] And on this, there's a lot of reasons why dentures don't necessarily fit well. I have a woman right now who has a hole in the top of her denture that is... Impairing the suction ability. So even if you put on the glue and yes, like shove it up against her gums for the appropriate amount of time, they will not stick because there's a crack in the center of it that is making it so the suction function can't adhere. Also, speaking of my mom, she taught me that the lower ones, I was always like, my patients have a really hard time with their lower dentures staying still. And she's like, well, there's never going to be the same level of suction because there isn't the same coverage capacity. So the suction ability of the lower denture will just never be as strong as the upper denture.

[14:22] And Emily got me hip actually to how to check someone's fit. Well, you want to tell us, Emily, how you make sure? So anytime I do a bedside and I notice somebody's wearing their dentures, I literally just pop on gloves and give them a little wiggle. Like, I open their mouth and I'll grab their teeth and I'll wiggle them, see if they move. Like, are they going to move with my pressure? I mean... They're removable teeth there should be a little bit of give but they shouldn't be like clacking around so that's always a good thing don't be afraid to have your patient open their mouth and, really mess with them like see is it a state well if you give a mistake and they're trying to chew it those teeth will move you should find as well see how their teeth are going to react with some pressure. Definitely, definitely. And, you know, both research articles commented on reduced sensation, reduced oral sensation.

[15:25] And so one of the things that we do need to check is that physical feedback, the asking somebody, hey, does it feel like a good fit? Does it feel like you are fully aware of the food in your mouth? They may not have fully appropriate responses because of that reduced sensation. So making sure you're checking in with them throughout oral trials, giving them some feedback of things that you're seeing. Like, oh, hey, I noticed that it's taking a little bit of a while to clear things out of your mouth. Do you still feel the food on your tongue? You know, those are all appropriate things to be checking in with your patients on.

[16:01] There was not too long ago, I had a patient who, she was eating breakfast. It was already a mechanicalized plate. So ground sausage, eggs. And I noticed throughout her meal, she kept having little pieces and I would check her oral cavity and there was nothing. It took like 10 minutes. And I was like, let me just see. And I popped out her top dentures and the whole top of it was totally filled with ground sausage. I was like, okay, that's enough. It's an immediate learning moment i'm like so this is what's happening your your dentures aren't fitting great food is collecting in the top part of your dentures like you we're just gonna not wear them because it just puts you at a greater risk especially if you have them in foods up there and it falls down if you're sleeping so immediately i just it's one of those times where educated patient educated the STNAs.

[17:03] Let the nurse know that dentures are not going to be a good option for this person right now. It's an gross thing. I do love those moments where you're working with a patient. You're like, do you see how there's a ton of food up there? And they're like, huh, I guess like ground sausage stuck in my mouth. Isn't like a great situation? You're like, oh, yeah, I agree. But one thing One thing I did want to bring us back to is Emily and I are always talking about oral phase dysphagia because it impacts all the other stages.

[17:41] But also, it doesn't necessarily have to be something that's like mechanically wrong, right? So when dentures rub or are ill-fitting, they can cause lesions. They can cause cuts. They can cause open sores in the mouth. And so after reading this research, it really inspired me to start asking people to take their dentures out of their mouth. As soon as someone, you know, now I ask them, like, hey, are those your teeth? They someone else's? No. Are they your teeth? that, you know, are they dentures? If they say dentures, I ask them to take them out for me. We make sure there's nothing in there that I'm like, oh, hey, by the way, have you noticed all this collecting food? But also I ask them to run their tongue over their gums, over the top of their mouth. Does anything hurt? Does anything feel uncomfortable? Because if somebody is in pain while they're chewing, they're not going to chew as well. And it leads to them trying to swallow chunkier pieces of food because they don't want to spend the time chewing. It hurts too much to chew. So they start gulping things in a way that we don't want them to be gulping.

[18:42] And this lady, the one who had the denture fracture, I would just every once in a while be like, all right, I'm going to put on gloves and just would touch the top of the roof of her mouth, give her a little hard palate, a tickle. Does that hurt? Because I wanted to see if where the crack was was starting to cause any cuts or bleeding or anything like that. And it was fine. she was fine but unfortunately those dentures are never going to fit again sad so i was going around being like where are my d's why can't i have them i was like oh sorry hon dentures are hard to get like once and they're hard to get fit you have your um mandible once you have all your teeth gone there's nothing in there providing any extra support so you start to get bone reabsorption absorption.

[19:29] And your bottom dentures just decline fitting over time, just very naturally. So it's important to get refit every three years to make sure you are always having dentures that fit. Yeah. And in terms of our takeaways, so today's research explored the significant connections between dentures, chewing, and swallowing. And we noted that while dentures can offer a lot of benefits such as mechanical gains or grinding ability on our food, a proper fit really is essential for safe and efficient swallowing. And as SLPs, we can play an important role by incorporating denture considerations into our evaluations, educating patients, and advocating for proper dental care. And again, that goes back to that team, you know, building level approach.

[20:15] And guess what? We made you something. Just for you. Just for you. We made a document. It's both an in-service and something you can add into your evaluations. It's sort of a checklist. It goes through and you can just circle things that, build a profile for your patient's denture use. So it says, you know, social usage. Do they wear during meals? Are they reporting difficulty? Does patient have any concerns? Are they ill-fitting? And then that's something you can take, show as an in-service to your team on the unit, your CNAs, your other rehab team members, and say, hey, this is what we're seeing. These are patient concerns. This is what we'd like to see in terms of changes in eating. And that will help you create a better documentation process for patients eating and swallowing with denture considerations in mind. And also, before I forget, weight loss. Oh, yes. When people lose weight, their gums change. So somebody who might get flagged for a change in weight loss may go from having proper fitting dentures to ill-fitting dentures. So even your dieticians are important people to have on your side in the denture discussion.

[21:37] I don't know why I said it like that. That was weird. I loved it, though. So supportive. And as always, leave us a comment. Tell us how you thought this episode went. Give us ideas for future episodes. Yeah. What was helpful? What wasn't? Tell us what you're thinking. What are you seeing in clinic? All right. Talk to you next week.

[22:00] 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.com. If you want even more speech talk content, check out our website at speech talk pod.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 Aaron 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.

[23:21] Music.