Mouth Care Tips

Does mouth care stress you out? Follow these tips for better mouth care in  your  facility.

    • Talk about MOUTH care instead of oral care.
  • Talk about FACTS
    • Good mouth care can PREVENT 1 in 10 pneumonias***
    • Brush 2 mins 2x a day
    • By writing GOALS for mouth care, you can spend BILLABLE TIME training staff
      • Example,”Pt will spit two times during mouth care with cues from assisting staff to reduce the risk of developing aspiration pneumonia.”
      • YOUR SKILL is the skill of assessing:
        • who is at risk to develop PNA
        • how that risk can be reduced
  • And don’t forget to PICK AND CHOOSE your battles…
    • Soak dentures, BUT STILL BRUSH THEM
    • FLOSSING makes MORE OF A DIFFERENCE than brushing
    • BAN TOOTHETTES for residents with teeth
    • If you have to skip the toothpaste, so be it.  BRUSHING is what makes the difference.
  • Train staff to be patient—Not every resident will allow mouth care right away.  Relationship building is a huge part of successful mouth care programming.  Other helpful hints:
    • Sing to the resident
    • Use a mirror so they can watch
    • Use hand over hand to facilitate participation and carryover

See the evidence with SDX

You know that an SDX FEES gives you the freedom of testing REAL food right in the resident’s room, in their typical eating position, allowing the resident to eat independently or even to be fed by staff or family members.  You know an SDX FEES is the optimal test for a resident when you are concerned about fatigue.
But do you know…
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A FEES provides that perfect top-down view that lets us actually view the tissue, identifying atypical redness, edema and cobblestoning that accompany reflux.  Because we are able to view after the swallow, we can keep monitoring for cricopharyngeal backflow as long as needed during a FEES.  When backflow occurs, we can then assess for the resident’s reaction, looking for the triggering of a reswallow and backflow clearance, or identifying the resident’s inability to clear the backflow.  Unlike an MBS, an SDX FEES lets you see what happens CONTINUOUSLY, with no “on and off” switch.
Know what’s really happening even after the swallow with SDX FEES!
 If you think your resident is having pharyngeal dysphagia complications with an underlying reflux, call your SDX FEES Specialist to review the case.
An SDX FEES can help identify strategies that work to minimize the impact of backflow.  Full-color photos actually show tissue irritation, facilitating MD diagnosis and treatment of reflux.


Alzheimer’s and Caregiving

alzheimers-fb I am getting on my soapbox and talking about the role of the SLP as a primary caregiver to residents with dementia and dysphagia.  When our resident stops eating, what do we do? What do we recommend when we do a FEES and see that nearly all consistencies are aspirated?  How do we document these recommendations?
To tube or not to tube is not our decision to make, but it is within our scope to provide education to residents, their caregivers, and our facility staff.  ASHA provides guidance to the SLP through Frequently Asked Questions About Alternative Nutrition and Hydration, a document created by Special Interest Group 13, Swallowing and Swallowing Disorders.  Click here to visit ASHA’s resource page for end of life issues in SLP.
There are references galore that instruct residents, families, and other professionals to use the support of the interdisciplinary team to assist in decision making, and most importantly in this process, to be guided by the facts.  Three stellar position papers are linked below:
The American Geriatrics Society presented an updated Feeding Tubes in Advanced Dementia Position Statement  in July of this year.  It gives strong rationales for its position that feeding tubes are not recommended for older adults with advanced dementia, and that careful oral (hand) feeding should be offered because it is “at least as good as tube feeding for the outcomes of death, aspiration pneumonia, functional status, and comfort.”
From the Alzheimer’s Association, 

be shared with a resident’s decision maker and other family members, as well as other professionals.  It emphasizes the benefits of assisted oral feeding over a PEG, and discusses the importance of advanced directives planning for residents with dementia.  

The Position of the Academy of Nutrition and Dietetics: Ethical and Legal Issues in Feeding and Hydration discusses the importance of a supportive interdisciplinary effort using a culturally respectful approach to support families and caregivers through their decision making process.  It emphasizes the individual’s “right to request or withhold nutrition or hydration as medical treatment.”

It is our professional and ethical responsibility, and well within our scope of practice as SLPs working with long-term care residents, to document not only what is safest for a resident but to additionally comment on (1) the resident’s prognosis for developing aspiration complications and (2) quality of life considerations.

Dementia is commonly considered in the research to be a terminal illness, and as such, it is appropriate for an SLP to explain in documentation that while there is risk of prandial aspiration with oral feedings, that the placement of a PEG tube will further increase the resident’s risk of developing complications like aspiration pneumonia.

Furthermore, nonoral nutrition is shown in the research to have no positive impact on quality of life in residents with dementia.  In a time where the focus is on evidence-based practice, it is important to be well-versed in the current research about PEG tubes and dementia, and to be able to fluently discuss both the pros and cons with residents, their caregivers, and other professionals.


SLPs have the power to be the voice of reason when PEG tubes are discussed for residents with dementia.  Rely on the research to guide your professional judgment and step up in the discussion for your residents and for their dignity.


More Success by Saying Less


Those of you who know me know how much I talk…I’m a speech therapist right?  Well, turns out saying less CAN mean more. I had the pleasure of participating in LSVT LOUD.  It is a very dynamic training with research to support its success.  It really got me thinking, how can I help my dysphagia clients with what I just learned?  I can do a FEES, I can establish how to make a difference, but how do I invest my patient in therapy?  If I can make therapy meaningful to my resident, carryover can be successful!
Next time you are getting frustrated with training swallowing strategies, ask yourself:

Why does this matter to the resident?

  • Make it a point to connect therapy to their wants and needs…do they want to eat without being embarrassed by their coughing?  Do they want to stay healthy for the next 6 months to attend a grandchild’s wedding?  Do they want to be able to eat prime rib at that event?
Take a step back.  Think about what you are asking of the resident.  Focus on their abilities and teach to their abilities.
“Do what I do” are 4 of the most powerful words in teaching a skill.  Remove the thinking about what they need to do, stop talking about what they need to do, and teach the skill by example–SHOW what they need to do by doing it yourself first. Show it over and over again, and aim to make it automatic.  Be persistent, and be consistent! Gandhi’s wisdom can be taken literally when you practice being the change you wish to see.



Medically speaking Dysphagia is defined as the “difficulty or discomfort in swallowing, as a symptom of disease.” That will be the only boring medical definition that will be used for this blog. I want to educate people on swallowing disorders however I do not want to bore you to death. My goal with this blog is to make swallowing disorders, alongside other medical topics that will be discussed, as interesting and informing as possible. yMy job as a FEES specialist entails half of my work week being spent in the office doing paperwork while the other half is spent in the field hands on with our clients. This blog will consist of memoirs of my field visits with clients and discussions regarding current news in the medical field. I hope my follower bloggers and medical readers find this blog informative but written in a way that makes a stereotyped medical field easy to comprehend for all.

Below I have listed all of SDX Dysphagia Experts social media outlets, that way you can stay connected even outside of this blog.


Twitter: sdx_fees

Instagram: sdxslpsluv2fees

Facebook: SDX Dysphagia Experts