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Article written by: Silvia Meléndez-BriskieM.S., CCC-SLP

Life is full of adventures, mishaps and learning experiences. Each of us has a story at how we have arrived to where we are in our profession. My adventure began after 19 years of working in the legal field. I decided to leave that path after witnessing a session treatment when a family member needed the services of a speech-language pathologist. After completing pre-requisites, I was fortunately accepted to the master’s program at Nova Southeastern University, and I began the life of a student, again.

In 2009, I completed my adult clinical practicum at an outpatient rehabilitation center where my then linear grad school life would change. After graduation, I was determined to work primarily with children, but life threw a curveball and I found myself working with a spectrum of ages: pediatrics, adults and geriatrics. Since then, I have been treating patients with aphasia, voice disorders, other neurogenic disorders, and dysphagia.

ice waterDysphagia is such a complex specialty in our profession that I was concerned about particular factors that I often found present in my patients: most showed halitosis [bad breath] and xerostomia [dry mouth]- usually caused by medication. Seeing this, I became interested in learning more about how our role as SLPs fit into the oral hygienic aspects and how I can provide information to my patients, caretakers and staff about oral hygiene.

Our role as SLPs is to advocate for our patients. So, I decided to investigate the matter further. While we already know oral care maintenance helps prevent the development of future and painful worrisome conditions, the oral cavity of the elderly, or ill, will be susceptible to become easily affected by health and medications. There has been much literature written about this topic; however, it is often not practiced in healthcare settings. According to the authors Ashford and Skelley (2008) “[t]he environment of the oropharyngeal cavity has become a leading point of interest as the potential source of potentially infectious organisms, or pathogens, which, if aspirated, may colonize and infect the lower respiratory system. Preemptive care and maintenance of the oral cavity have been shown to control the colonization of these pathogens and reduce the incidence of pneumonia development among the sick and elderly.” (p. 19).

teaNavigating the health care world is complex. Organizations such as skill nursing facilities, long term care, etc., follow their own protocols and procedures. Thus far, I have been fortunate to have been exposed to different healthcare environments over the years. During a recent PRN assignment, I found in 5 out of 8 patients whose oral health status had not been managed appropriately.  For example, a couple of partially dentulous patients displayed plaque and severe halitosis. I was concerned about this because I believed that the facility staff cared for the patients. Yet, I was seeing with my own eyes, the opposite. I requested to see the facility’s oral care protocol and I was told by a staff member there was none.

Ashford and Skelley (2008) also mentioned in the article, “[w]hile concerted programs of oral hygiene and their effects have been reported, standardized practices and protocols across care facilities have not been adopted nationally. . . . In most settings, nurses and nursing assistants are generally considered the responsible parties for seeing that oral hygiene care is carried out properly. . . . however, review of patient flow sheets [indicate] oral care [is provided] only 1.2 times per day.” (p. 22).

This experience encouraged me to take action and create a booklet of oral hygiene care for health care staff and other disciplines. To assert the authors’ reporting, it is imperative for SLPs to continue to advocate for their clients/patients by providing knowledge and resources to institutions’ staff about the importance of oral care and preventative development of possible pneumonia.

Ashford, J. R. & Skelley. M. (2008). Oral care and the elderly. Perspectives on Swallowing and Swallowing Disorders (Dysphagia). 3(17), 119-26.

Silvia Meléndez-Briskie, M.S., CCC-SLP, is a certified speech-language pathologist, a certified bilingual speech-language-pathologist, LSVT Certified (Lee Silverman Voice Treatment), a certified teacher of students with speech and language disabilities (TSSLD) in New York City, and MDTP trained- certification-in-progress (McNeill Dysphagia Therapy Program). She is the director and owner of Easy Bilingual Speech, LLC. Her practice specializes in assessing, diagnosing and treating all spectrums of ages with language, speech, neurogenic disorders, fluency, voice and swallowing. Her areas of specialty are: bilingualism, voice, and dysphagia. She is a member of the American Speech-Language-Hearing Association and the International Association of Logopedics and Phoniatrics. She is currently working on an oral care workbook resource. She can be reached directly at bilingualspeechslp@yahoo.com .

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