Dry Mouth in Spinal Cord Injury

Transcription

1 Dry Mouth in Spinal Cord Injury Jackie McRae Speech & Language Therapist London Spinal Cord Injury Centre Royal National Orthopaedic Hospital Stanmore

2 Imagine...

3 The nature of SCI Damage to the central spinal cord protected by the bony spinal column. Causes: Trauma, infection, surgery Affects transmission of neurological information between the brain and other parts of the body Muscle paralysis Bladder & bowel dysfunction = Physical, psychological and emotional impacts

4 Medical management Acute care -stabilise patient and neurovascular systems Long term - maintain systems and health preservation Problems: - spasticity - breathing - mood - appetite - bladder and bowel - autonomic dysfunction

5 Medication Disorder Bladder impairment Spasticity Gastric reflux Hypotension Mood Ventilation Dysphagia Pain Medication Oxybutynin/Tolterodine/ Solifenacin Baclofen/Tizanidine/ Dantrolene Omeprazole/Lansoprazole Ephedrine Citalopram/Sertraline Oxygen therapy NG/PEG feed Paracetamol Scully (2003)

6 Why is saliva important? 98% water 2% electrolytes, mucus, anti bacterial compounds, and various enzymes Functions: Digestion Taste Lubrication for speech and swallowing Anti-bacterial

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8 Presenting problems Constant dry mouth, dry flaky lips Dry, coated tongue, reduced mobility Quiet/croaky speech/effortful comm Sticky secretions in throat Sleep disturbance Blocked nose, smell distortions Sore or painful throat Swallowing problems, especially dry foods Reduced appetite

9 Xerostomia vs. hyposalivation Negative Impact on general well-being and social relations Oral Function Dry mouth Problems with teeth and oral mucosa Eating and swallowing difficulties Speaking difficulties Interrelation Forlornness Unsympathetic Ignorance Fatigue-anxiety dependence From Folke et al (unpublished observations) Nederfors (2000) Xerostomia and Hyposalivation

10 Patients solutions AVOID the medication? Grapes Regular water sips Sucking sweets Chewing gum Mouth gargles BUT all of these have detrimental side effects, so long term use not valuable

11 Traditional management Oral hygiene/vap CHLORHEXIDINE Synthetic Saliva GLANDOSANE Saliva stimulating tablets (SST) Thayers dry mouth spray

12 Oral hygiene Who? When? How? What?

13 And beyond... Oral hygiene products mouthwash/ toothpaste Mouth gel/spray Sucking tablets Sugar free Chewing gum

14 Protocol Develop a method to accurately identify patients with dry mouth. Discussion and education around mouthcare, hydration and mouth moisturising for pt, carers, staff Provide saliva substitute options gels, spray, sucking tablets and chewing gum Patient Feedback...

15 Preliminary protocol for managing Dry Mouth in patients with Spinal Cord Injury Identify patients on listed medication causing dry mouth discuss with Consultant and Pharmacist Ascertain dry mouth symptoms either by patient report or brief questionnaire Refer to Dietitian and Speech & Language Therapist if there are swallowing/speech/nutrition issues Commence Oral Hygiene Programme and offer saliva substitutes and stimulants Review after 2 weeks If symptoms not alleviated review medication, oral intake, hydration and use of artificial saliva products

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17 Google scholar search 22,600 results Mentioned only as a side effect of bladder management, pain management, spasticity PubMed 25 results 24 articles mention as pharmacology related problems, 1 specifically refers to oral health in SCI

18 Factors Associated With Oral Problems Among Adults With Spinal Cord Injury Yuen, Shotwell, Magruder, Slate, Salinas J Spinal Cord Med. 2009;32(4): online survey, USA, 192 responses; 47% report oral problems were positively associated with dry mouth symptoms, financial barriers to dental care access, smoking, and paraplegia

19 Next steps Identify level of need how many people does this affect and for how long? Hyposalivation or dry mouth? Patient group data Inpatients vs. Outpatients, medication, existing mouthcare, nutrition... Changes over time? What sort of product works best?

20 The BIG question Can we improve the quality of life of SCI pts with dry mouth?

21 Thanks to... Patients and colleagues at RNOH and NPH Fiona RIS products jackie.mcrae@rnoh.nhs.uk

22 References Nederfors (2000) Xerostomia and Hyposalivation, Adv. Dent. Res.14; 48 Yuen et al. (2009) Factors associated with Oral Problems Among Adults with Spinal Cord Injury J Spinal Cord Med. 32 (4): Scully (2003) Drug effects on salivary glands:dry mouth Oral Diseases 9,