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[Dysphagia] mouthrinse efficacy and safety reference and denture care
A good reference for a review of the safety and efficacy of
over-the-counter mouthrinses may be found in an FDA document:
Department of Health and Human Services: Oral health care drug products
for over-the-counter human use; antigingivitis/antiplaque drug
products; establishment of a monograph; proposed rules. Federal
Register 68(103):32231-32287, 2003
The mouthrinse with the highest safety and efficacy rating from the FDA
in this document is that which contains cetylpyridinium chloride. The
FDA deems peroxide safe, but not as effective as CPC. Sage Products
and Crest ProHealth contain CPC. Many patients find peroxide to be too
irritating, as well.
A senior technician with Dentsply International, the company that
produces the material that is used to manufacture most of the dentures
sold worldwide, recommends soaking dentures after brushing them in a
denture cleaning product or Hydrogen peroxide (even 3%) for no more
than 15 minutes. Dentures should be stored in a clean denture cup in a
small amount of water (1/8th inch or 30 cc) for humidification purposes.
S. Petrik, M.S., CCC-SLP
-----Original Message-----
From: JoAnn Eaton <joanneaton at charter.net>
To: Rehabstaff <rehabstaff at graceworks.org>; dysphagia at dysphagia.com
Sent: Thu, 14 Jun 2007 3:23 pm
Subject: Re: [Dysphagia] thickened liquid and the elderly.
It is my understanding that a peroxide rinse is contraindicated because
it
will also kill the good bacteria in the mouth. My understanding is that
a
50-50 peroxide/water solution should be used to clean dentures and
partials
through overnight soaking, but not used as a mouth rinse.
As far as the hydration issue is concerned, some facilities have
activities
initiate a group activity where refreshments are part of it and serve
water
right away and have people drink it over the course of the event.
It seems to help.
JoAnn
----- Original Message -----
From: "Rehabstaff" <rehabstaff at graceworks.org>
To: <dysphagia at dysphagia.com>
Sent: Thursday, June 14, 2007 1:29 PM
Subject: Re: [Dysphagia] thickened liquid and the elderly.
> I've used the free water protocol with selected geriatric patients for
> about 2 years. Usually they are so excited the first few days to have
> water they drink a lot but then their intake tapers off. We are
> continuing to look at this issue. Patient satisfaction and tolerance
of
> thickened liquids has antidotally improved.
>
> I am trying to implement a free water protocol for the entire 49 bed
> rehab unit then hopefully the whole facility (~ 300+ beds in house).
> However, before fully implementing, we are addressing improving oral
> care. I would strongly encourage anyone implementing the free water
> protocol to pay particular attention to oral care - especially using a
> 1.5% peroxide rinse.
>
> Peace,
> Sonja Dragich M.A., CCC-SLP
> Graceworks Lutheran Services
>
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> -----Original Message-----
> From: dysphagia-request at dysphagia.com
> [mailto:dysphagia-request at dysphagia.com]
> Sent: Thursday, June 14, 2007 7:36 AM
> To: dysphagia at dysphagia.com
> Subject: Dysphagia Digest, Vol 43, Issue 17
>
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> Today's Topics:
>
> 1. training CNA's (Ninon Dovalina)
> 2. Frazier Water protocol screening form (Irene Campbell-Taylor)
> 3. Thickened liquids: Tetrapacs vs on-site thickening
> (Walsh, Linda (R1SE))
> 4. Re: training CNA's (JoAnn Eaton)
> 5. Practice approaches (Irene Campbell-Taylor)
> 6. Re: Practice approaches (Vera Karger)
> 7. Re: Practice approaches (gerriann jackson)
> 8. Re: Practice approaches (Deanna Rolfe)
> 9. Re: Practice approaches (Irene Campbell-Taylor)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Wed, 13 Jun 2007 15:02:48 -0700 (PDT)
> From: Ninon Dovalina <ninonslp at yahoo.com>
> Subject: [Dysphagia] training CNA's
> To: Dysphagia at dysphagia.com
> Message-ID: <657796.31977.qm at web55011.mail.re4.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> Hello everyone,
>
> I just started working at a SNF and was wondering if anyone has any
> advice on how to best
> train CNA"s and other staff to follow swallow strategies and diet
> recommendations.
> In the short time I have been at this facility, we have been able to
> establish the use of personalized bracelets to alert staff that a
person
> is on nectar liquids. That seems to be working out well thus far.
> However, compliance with the rest of recommendations (upright feeding,
> small bites, alternate between solids and liquids,etc) does not seem
to
> be working out very well.
>
> Any ideas are appreciated greatly!
>
> Thanks
>
>
>
> ---------------------------------
> Sick sense of humor? Visit Yahoo! TV's Comedy with an Edge to see
what's
> on, when.
>
> ------------------------------
>
> Message: 2
> Date: Wed, 13 Jun 2007 15:05:40 -0700 (PDT)
> From: Irene Campbell-Taylor <eripley at yahoo.com>
> Subject: [Dysphagia] Frazier Water protocol screening form
> To: dysphagia at b9.com
> Message-ID: <997920.68622.qm at web30202.mail.mud.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> I continue to be amazed at the concern about drinking water and the
> possibility of aspiration. The Frazier hospital has been using this
> approach for, I believe, over 20 years with no problems - or they
> wouldn't still be using it. The most dangerous thing one can aspirate
> mot of the time - barring something that will block the airway or oil,
> acid or large amounts of vomitus - is one's own saliva. It is possible
> to drown in relatively clear water and come to no harm- at 88ml of
water
> per kg of body weight required for drowning hypoxia. And, to cap it
all,
> until relatively recently, bronchograms were done by deliberately
> injecting barium and water into the lung. How much harm can a few
> mouthfuls of tap water possibly do? There's at least one judge - in
> Montana- who decided that water was just fine for adults with DD in a
> major center and to date, no problems have arisen - over five years.
Can
> we just apply known physiology and common sense?
>
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
>
> ------------------------------
>
> Message: 3
> Date: Wed, 13 Jun 2007 19:11:40 -0300
> From: "Walsh, Linda \(R1SE\)" <Linda.Walsh at serha.ca>
> Subject: [Dysphagia] Thickened liquids: Tetrapacs vs on-site
> thickening
> To: <dysphagia at dysphagia.com>
> Message-ID: <09957DD31ECEB94FAAD90F6D31FDD433B4229A at RHAEX1.RHA-RRS.CA>
> Content-Type: text/plain; charset="utf-8"
>
> A few years ago we SLPs worked with our Food Services Dept to alter
> their recipes for soups and liquids to make them safer for patients
who
> clearly aspirate thin liquids. This was an improvement over the
previous
> process of thickening liquids at the bedside, but we find it is still
> inconsistent. We would like to move to using some of the thickened
> liquids available commercially in tetrapacs but our hospital insists
it
> will be more expensive. Has anyone done a cost-analysis taking into
> account wastage if products are not acceptable to patients?
>
> Thanks for any info sharing.
>
> Linda
>
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> Merci.
>
> ------------------------------
>
> Message: 4
> Date: Wed, 13 Jun 2007 19:26:29 -0500
> From: "JoAnn Eaton" <joanneaton at charter.net>
> Subject: Re: [Dysphagia] training CNA's
> To: "Ninon Dovalina" <ninonslp at yahoo.com>, <Dysphagia at dysphagia.com>
> Message-ID: <001901c7ae1a$a72faa10$0201a8c0 at CPQ14954210161>
> Content-Type: text/plain; format=flowed; charset="iso-8859-1";
> reply-type=original
>
> Get yourself scheduled for a mandatory in-service. Sometimes the
> facility
> will videotape it for those who can't attend. You develop a handout
> related
> to dysphagia and they can get credit for a one-hour in-service for
their
>
> licensing if they take a post-test of a few basic questions. I also
> promise
> treats. . . little do they know.
>
> Experienced, long-empoyed CNAs in the facilities have learned not to
sit
>
> close to where I do the in-service because I usually pick someone
close
> to
> be my "resident" during the interactive part of the in-service.
> We cover positioning, bite size, etc. in the lecture portion with me
> using
> examples of real residents and explain the "why" of certain
> recommendations.
> Then the fun begins. I've already passed out the juice and cookies or
> rolls,
> etc. Whatever the treat is to be. As I discuss positioning, there will
> be
> one close at hand who is slouched as she listens. So, I bring a clean
> glass
> of water over as I'm moving around the front of the room and say,
"This
> is
> why positioning is so important" and grab my "victim" and start giving
> her
> the drink. While I do this, I may talk to the CNA next to her and
don't
> look
> directly. If I notice a problem with this in the dining room, I'll
even
> start talking to the CNA about someone (made up name NOT on staff)
> getting
> wasted over the weekend or complaining about how someone wasn't
helping
> like
> they should. (They get the picture about appropriate communication.)
> Usually
> there is a startle reaction from the person getting the drink. Then I
> ask
> her to describe how she felt about being served in that way. It's a
> great
> opportunity to talk about positioning, mental prepping the resident
for
> what's coming, etc. Then I have her sit upright and model the
"perfect"
> feeding assistance. After that, all the attendees pair off and
practice
> giving food and drink to their partners in good positioning and bad.
> With
> large bites or small. Did I mention that I often use thickener
packets
> and
> have them try to thicken the juice?
> This workshop often gets lots of discussion going. I usually run out
of
> time. We cover mental set, how to offer choices, ways to reduce
> combative
> behavior by giving choices or letting someone know before they start
> moving
> them what they are doing.
>>From the feedback, this is one of the most popular in-services they
> have.
> (They also like the prizes and real candy treats they get as they
> leave.)
> Good luck!
> JoAnn Eaton
> ----- Original Message -----
> From: "Ninon Dovalina" <ninonslp at yahoo.com>
> To: <Dysphagia at dysphagia.com>
> Sent: Wednesday, June 13, 2007 5:02 PM
> Subject: [Dysphagia] training CNA's
>
>
>> Hello everyone,
>>
>> I just started working at a SNF and was wondering if anyone has any
>> advice on how to best
>> train CNA"s and other staff to follow swallow strategies and diet
>> recommendations.
>> In the short time I have been at this facility, we have been able to
>> establish the use of personalized bracelets to alert staff that a
> person
>> is on nectar liquids. That seems to be working out well thus far.
>> However, compliance with the rest of recommendations (upright
feeding,
>
>> small bites, alternate between solids and liquids,etc) does not seem
> to be
>> working out very well.
>>
>> Any ideas are appreciated greatly!
>>
>> Thanks
>>
>>
>>
>> ---------------------------------
>> Sick sense of humor? Visit Yahoo! TV's Comedy with an Edge to see
> what's
>> on, when.
>> _______________________________________________
>> Dysphagia mail list: Normal and disordered swallowing information
>> Dysphagia at dysphagia.com
>> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
>> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>>
>
>
>
>
> ------------------------------
>
> Message: 5
> Date: Wed, 13 Jun 2007 18:26:46 -0700 (PDT)
> From: Irene Campbell-Taylor <eripley at yahoo.com>
> Subject: [Dysphagia] Practice approaches
> To: dysphagia at b9.com
> Message-ID: <163275.24898.qm at web30204.mail.mud.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> I have the impression from recent posts that few, if any, are paying
> heed to Logemann's findings on the dangers of thickened fluids in the
> elderly in long term care- dehydration, aspiration of thickened
liquids
> etc. Why continue with something that has long been known and now
proven
> to be dangerous?
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
>
> ------------------------------
>
> Message: 6
> Date: Wed, 13 Jun 2007 21:38:41 -0400
> From: Vera Karger <vkargerslp at mac.com>
> Subject: Re: [Dysphagia] Practice approaches
> To: Irene Campbell-Taylor <eripley at yahoo.com>
> Cc: dysphagia at b9.com
> Message-ID: <396F0D1B-318F-4B5F-AEC6-8A57086373E6 at mac.com>
> Content-Type: text/plain; charset=US-ASCII; delsp=yes;
> format=flowed
>
> Irene,
> I'm relieved to be able to return my patients to water. They are as
> well.
> Not having read the study directly, perhaps you can fill me - us - in
> on whether it's suggested that a squeeze of lemon, lime or perhaps
> juice for flavoring may be used? Some patients really dislike plain
> water.
>
> Vera Karger, M.S., CCCS
> Monroe, CT
> vkargerslp at mac.com
>
>
>
> On Jun 13, 2007, at 9:26 PM, Irene Campbell-Taylor wrote:
>
>> I have the impression from recent posts that few, if any, are
>> paying heed to Logemann's findings on the dangers of thickened
>> fluids in the elderly in long term care- dehydration, aspiration of
>> thickened liquids etc. Why continue with something that has long
>> been known and now proven to be dangerous?
>>
>> Dr I Campbell-Taylor
>> Clinical Neuroscientist
>> Exclusive Distributor:
>> www.interactivetherapy.com
>> _______________________________________________
>> Dysphagia mail list: Normal and disordered swallowing information
>> Dysphagia at dysphagia.com
>> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
>> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
>
>
> ------------------------------
>
> Message: 7
> Date: Wed, 13 Jun 2007 21:53:09 -0400
> From: "gerriann jackson" <gjackson at rochester.rr.com>
> Subject: Re: [Dysphagia] Practice approaches
> To: "Vera Karger" <vkargerslp at mac.com>, "Irene Campbell-Taylor"
> <eripley at yahoo.com>
> Cc: dysphagia at b9.com
> Message-ID: <MDEHIFEODKBJKNEJHBDCGEHOCJAA.gjackson at rochester.rr.com>
> Content-Type: text/plain; charset="us-ascii"
>
>
>
> I promote free water between meals, after oral care for my dysphagia
> patients. I cannot, however, ignore the many videos that I have
> performed
> that demonstrate quite clearly a person aspirating on thin and
> tolerating
> thickened liquids. Nor can I ignore the patients who I follow over
time
> (LTC attached to hospital) who have experienced relief from chronic
> upper
> respiratory symptoms, including repeated pneumonias after being placed
> on
> thickened liquids.
>
> Research and evidence based practice are important to my practice.
> However,
> there is also evidence and knowledge to be gleaned from every patient
> that I
> treat. Those patients and their outcomes tell me that although
probably
> overused, there is an appropriate place for thickened liquids in the
LTC
> setting.
>
> Gerriann Jackson
>
> -----Original Message-----
> From: dysphagia-bounces at dysphagia.com
> [mailto:dysphagia-bounces at dysphagia.com]On Behalf Of Vera Karger
> Sent: Wednesday, June 13, 2007 9:39 PM
> To: Irene Campbell-Taylor
> Cc: dysphagia at b9.com
> Subject: Re: [Dysphagia] Practice approaches
>
>
> Irene,
> I'm relieved to be able to return my patients to water. They are as
> well.
> Not having read the study directly, perhaps you can fill me - us - in
> on whether it's suggested that a squeeze of lemon, lime or perhaps
> juice for flavoring may be used? Some patients really dislike plain
> water.
>
> Vera Karger, M.S., CCCS
> Monroe, CT
> vkargerslp at mac.com
>
>
>
> On Jun 13, 2007, at 9:26 PM, Irene Campbell-Taylor wrote:
>
>> I have the impression from recent posts that few, if any, are
>> paying heed to Logemann's findings on the dangers of thickened
>> fluids in the elderly in long term care- dehydration, aspiration of
>> thickened liquids etc. Why continue with something that has long
>> been known and now proven to be dangerous?
>>
>> Dr I Campbell-Taylor
>> Clinical Neuroscientist
>> Exclusive Distributor:
>> www.interactivetherapy.com
>> _______________________________________________
>> Dysphagia mail list: Normal and disordered swallowing information
>> Dysphagia at dysphagia.com
>> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
>> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
> _______________________________________________
> Dysphagia mail list: Normal and disordered swallowing information
> Dysphagia at dysphagia.com
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
>
>
> ------------------------------
>
> Message: 8
> Date: Thu, 14 Jun 2007 12:56:59 +1000
> From: "Deanna Rolfe" <drolfe at nsccahs.health.nsw.gov.au>
> Subject: Re: [Dysphagia] Practice approaches
> To: "Vera Karger" <vkargerslp at mac.com>, "gerriann jackson"
> <gjackson at rochester.rr.com>, "Irene Campbell-Taylor"
> <eripley at yahoo.com>
> Cc: dysphagia at b9.com
> Message-ID: <46713B1B020000C400005204 at mail.nsccahs.health.nsw.gov.au>
> Content-Type: text/plain; charset=US-ASCII
>
> I have had similar experiences, with some patients who prefer the
> thickened fluids as they find them easier to swallow/control, and stop
> them coughing, or they no longer have respiratory signs.
>
> I have had a number of elderly patients who have been admitted to
> hospital with dehydration, I get asked to see them, find they are
> coughing on fluids and then they refuse to have more after they
cough. I
> then try a nectar consistency...no coughing...patient drinks the whole
> cup. These are often patients who don't have the cognitive abilities
to
> implement compensatory techniques or therapy.
> I work across both inpatient acute services and outpatients, so I get
> to see people across the spectrum, and often find better outcomes with
> thickened fluids.
>
> So I, too, feel there is a place for them, but agree that they can be
> overused.
>
> Deanna
>
>>>> "gerriann jackson" <gjackson at rochester.rr.com> 14/06/2007 11:53:09
> AM >>>
>
>
> I promote free water between meals, after oral care for my dysphagia
> patients. I cannot, however, ignore the many videos that I have
> performed
> that demonstrate quite clearly a person aspirating on thin and
> tolerating
> thickened liquids. Nor can I ignore the patients who I follow over
> time
> (LTC attached to hospital) who have experienced relief from chronic
> upper
> respiratory symptoms, including repeated pneumonias after being placed
> on
> thickened liquids.
>
> Research and evidence based practice are important to my practice.
> However,
> there is also evidence and knowledge to be gleaned from every patient
> that I
> treat. Those patients and their outcomes tell me that although
> probably
> overused, there is an appropriate place for thickened liquids in the
> LTC
> setting.
>
> Gerriann Jackson
>
> -----Original Message-----
> From: dysphagia-bounces at dysphagia.com
> [mailto:dysphagia-bounces at dysphagia.com]On Behalf Of Vera Karger
> Sent: Wednesday, June 13, 2007 9:39 PM
> To: Irene Campbell-Taylor
> Cc: dysphagia at b9.com
> Subject: Re: [Dysphagia] Practice approaches
>
>
> Irene,
> I'm relieved to be able to return my patients to water. They are as
> well.
> Not having read the study directly, perhaps you can fill me - us - in
> on whether it's suggested that a squeeze of lemon, lime or perhaps
> juice for flavoring may be used? Some patients really dislike plain
> water.
>
> Vera Karger, M.S., CCCS
> Monroe, CT
> vkargerslp at mac.com
>
>
>
> On Jun 13, 2007, at 9:26 PM, Irene Campbell-Taylor wrote:
>
>> I have the impression from recent posts that few, if any, are
>> paying heed to Logemann's findings on the dangers of thickened
>> fluids in the elderly in long term care- dehydration, aspiration of
>> thickened liquids etc. Why continue with something that has long
>> been known and now proven to be dangerous?
>>
>> Dr I Campbell-Taylor
>> Clinical Neuroscientist
>> Exclusive Distributor:
>> www.interactivetherapy.com
>> _______________________________________________
>> Dysphagia mail list: Normal and disordered swallowing information
>> Dysphagia at dysphagia.com
>> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
>> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
> _______________________________________________
> Dysphagia mail list: Normal and disordered swallowing information
> Dysphagia at dysphagia.com
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
> _______________________________________________
> Dysphagia mail list: Normal and disordered swallowing information
> Dysphagia at dysphagia.com
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
>
> Disclaimer: This message is intended for the addressee named and may
> contain confidential information. If you are not the intended
recipient,
> please delete it and notify the sender. Views expressed in this
message
> are those of the individual sender, and are not necessarily the views
of
> Northern Sydney Central Coast Health.
> Please note: Northern Sydney Central Coast Health E-Mail addresses
have
> changed from @doh.health.nsw.gov.au to @nsccahs.health.nsw.gov.au
> Please make this change in your address books for my contact details.
>
>
>
> ------------------------------
>
> Message: 9
> Date: Thu, 14 Jun 2007 04:35:52 -0700 (PDT)
> From: Irene Campbell-Taylor <eripley at yahoo.com>
> Subject: Re: [Dysphagia] Practice approaches
> To: gerriann jackson <gjackson at rochester.rr.com>, Vera Karger
> <vkargerslp at mac.com>
> Cc: dysphagia at b9.com
> Message-ID: <336339.84110.qm at web30205.mail.mud.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
>
>
> gerriann jackson <gjackson at rochester.rr.com> wrote:
>
> I promote free water between meals, after oral care for my dysphagia
> patients.
>
> *** Even the best oral care can never remove all pathogens from the
> mouth. I cannot, however, ignore the many videos that I have performed
> that demonstrate quite clearly a person aspirating on thin and
> tolerating
> thickened liquids.
> *** You really must take these findings as what they are- not
relevant
> to real life. Logemann in her study on thickeners noted that the VFSS
> did not match the real life situation - it never does.
>
> Nor can I ignore the patients who I follow over time
> (LTC attached to hospital) who have experienced relief from chronic
> upper
> respiratory symptoms, including repeated pneumonias after being placed
> on
> thickened liquids.
> *** But you don't know all of the variables involved. They are,
> undoubtedly, aspirating the thickened liquids as well. See Logemann et
> al. Perhaps, for other reasons, their resistance is better. One
cannot
> assume that thickened liquids are not aspirated and we now know for
> certain that they are.
>
> Research and evidence based practice are important to my practice.
> However,
> there is also evidence and knowledge to be gleaned from every patient
> that I
> treat.
> *** Absolutely - but one must also know what changes, biochemical,
> pharmaceutical, immunological, etc. are taking place before reaching
> conclusions based on only one variable.
>
> Those patients and their outcomes tell me that although probably
> overused, there is an appropriate place for thickened liquids in the
LTC
> setting.
> *** I, of course, would have to disagree, and, having never used them
> find no reason to suggest that they do have any place - the recent
study
> supporting this conclusion.
>
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> End of Dysphagia Digest, Vol 43, Issue 17
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