Week 3 - Dysphagia

Question 1

what are the stages of a normal swallow?

Answer 1

• pre-swallow
• oral preparation
• oral stage
• pharyngeal stage
• oesophageal stage

Question 2

oral preparatory stage:

• what kind of process?
• how can the mechanical stage be bypassed?
• what occurs in the oral cavity?
• bolus is kept at?
• what is the duration?

Answer 2

• voluntary process
• when taking drinks quickly at once
• chewing, tasting, mixing with saliva to form bolus
• front of mouth
• duration is variable

Question 3

oral stage:

• what kind of process?
• what changes occur from the preparatory stage? how does it occur?
• how long does it last?

Answer 3

• also voluntary
• bolus is moved to back of the mouth, via the movement of the tongue
• lasts ~1 second

Question 4

pharyngeal stage:

• what kind of process?
• what does it involve the function of?

Answer 4

• involuntary stage
• involve function of valves to direct food through the pharynx, and to drive food through the pharynx into the oesophagus

Question 5

pharyngeal stage: what are the valves involved and how do they contribute to the process?
what is the “pressure generator” made of?

Answer 5

• velopharyngeal valve: prevents escape of food to the nasal cavity.
• cricopharyngeal valve: muscle helps food go down the pharynx
• pressure generator: base of tongue in contact with posterior pharyngeal wall

Question 6

oesophageal stage:
which anatomical structures involved?
what happens to respiration?
how long does this stage last?

Answer 6

• larynx lowers, returns to normal position
  cricopharyngeal contracts, preventing reflux of food
• respiration resumes
• 8-20 seconds

Question 7

what is a tipper and a dipper swallow?

Answer 7

tipper: tongue placed against incisors, bolus above the tongue
dipper: bolus beneath the anterior tip of tongue, tongue has to dip beneath bolus to elevate it above the tongue

Question 8

what are the 4 changes in swallowing associated with ageing?

Answer 8

• increased frequency of dipper swallow vs tipper
• delated pharyngeal elicitation
• loss of muscle reserve
• increased frequency of laryngeal penetration

Question 9

what are causes of dysphagia in older patients?

Answer 9

• dementia
• CVA: cerebrovascular accident
• poor OH
• thrush
• parkinson’s disease
• end of life

Question 10

causes of dysphagia in younger patients?

Answer 10

• head injury
• degenerative neurological disorders: motor neurone disease, multiple sclerosis, huntington’s disease
• facial trauma
• burns

Question 11

trisumus:

• what is it?
• why does it occur
• what is the mechanism that causes it?
• what functions does it affect?

Answer 11

• decreased oral aperture
• hypervascularity or neural damage, leading to:
• persistent contraction of masticatory muscles
• affects: articulation, resonance, swallowing, chewing, voice (elevates larynx)

Question 12

dry mouth: occurs with?

Answer 12

• radiotherapy
• medication/polypharmacy
• sjorgen’s syndrome
• thrush

Question 13

cleft lip & palate:
general issues with swallowing?
which stage do children usually have problems?

Answer 13

• rare to find issues with swallowing in affected adults, unless they have not had repairs as children
• usually problems with oral stage, but swallow and airway protection is ok

Question 14

what could be a sign of problems with swallowing?

Answer 14

• drooling
• coughing
• moist voice
• oral residue
• reduced laryngeal movement
• patient/carer concern

Question 15

effects of dysphagia?

Answer 15

• poor nutrition/diet; due to avoidance
• dehydration: not enough fluids
• recurrent chest infections
• UTI
• OH
• aspiration pneumonia
• death

Question 16

impact on dental practice:

caution with?

Answer 16

• patient’s posture: caution when lying flat, patient may choke if unable to manage own secretions