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Chacko SA, Ramamoorthy L, Cherian A, Anusuya R, Lalthanthuami HT, Subramaniyan R. Effectiveness of Swallowing and Oral Care Interventions on Oral Intake and Salivary Flow of Patients Following Endotracheal Extubation at a Tertiary Care Center: A Randomized Controlled Trial. J Caring Sci 2023; 12:213-220. [PMID: 38250001 PMCID: PMC10799270 DOI: 10.34172/jcs.2023.33005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/26/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Endotracheal intubation and mechanical ventilation are the most frequently used life-sustaining interventions in critical care. Prolonged intubation can lead to post-extubation dysphagia, affecting the individual's nutritional level and communication ability. Thereupon, this study aims to assess the effectiveness of swallowing and oral care interventions in resuming oral intake and increasing salivary flow in post-extubation patients. Methods A randomized controlled trial was conducted in critical care units of a tertiary care setting, where 92 post-extubation patients who had undergone intubation for≥48 hours were enrolled. The intervention group received swallowing and oral interventions, including safe swallowing education (SSE), toothbrushing, salivary gland massage, oral cavity, and swallowing exercises. In contrast, the control group received standard oral care every 8th hour. Oral intake was assessed daily with the Functional Oral Intake Scale, and the salivary flow measurement was assessed with oral Schirmer's test on the 1st, 3rd, and 7th day after extubation. Results The baseline demographic and clinical characteristics showed that the groups were homogenous. The intervention group achieved total oral intake two days earlier than the control group. Findings also showed that the participants in the intervention group had a significant increase in salivary flow than in the control group on the 3rd and 7th days of the intervention. Conclusion Swallowing and oral care interventions help post-extubation patients resume early oral intake and increase salivary flow after prolonged intubation. Hence, it improves the patient's outcome toward a healthy life.
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Affiliation(s)
- Sherill Ann Chacko
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Lakshmi Ramamoorthy
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Anusha Cherian
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - R Anusuya
- Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India
| | - HT Lalthanthuami
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Rani Subramaniyan
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Griffith A, Roy A, Kulkarni S, Simmons G, Osorno L, Kumar V. Proof of concept design for a toothbrush with on-board vacuum to reduce oral aspirates. Gerodontology 2023:10.1111/ger.12730. [PMID: 38009571 PMCID: PMC11128478 DOI: 10.1111/ger.12730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Over the course of brushing, aerosolised particles develop in the mouth. In individuals who do not have the ability to expel these oral aspirates, they can be inhaled and cause aspiration pneumonia. This article showcases a novel vacuum toothbrush, termed "ToothVac," and provides findings from its first human trial. METHODS The ToothVac device suctions saliva and aspirates during brushing, storing them in a removable reservoir at the bottom of the brush, to minimise the risk of inhalation and subsequent infection. Further descriptions of the various components of the ToothVac are included. This trial involved 18 participants who brushed using the ToothVac with the vacuum suction turned on and then off. RESULTS The volume of saliva produced was measured and compared. The ToothVac significantly reduced the amount of saliva that was produced by these participants when brushing. CONCLUSION The device has potential clinical potential in that it may reduce the risk of aspiration pneumonia and related lung infections. Potential future research may include clinical trials for specific indications or marketing for oral aspirate removal, as well as optimisation of brush design using injection moulding for scalable manufacturing.
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Affiliation(s)
- Alexandra Griffith
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, 07102
- Department of Biological Sciences, New Jersey Institute of Technology, Newark, NJ, 07102
- Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, NJ, 07102
- Department of Endodontics, Rutgers School of Dental Medicine, Newark, NJ, 07103
| | - Abhishek Roy
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, 07102
- Department of Biological Sciences, New Jersey Institute of Technology, Newark, NJ, 07102
- Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, NJ, 07102
- Department of Endodontics, Rutgers School of Dental Medicine, Newark, NJ, 07103
| | - Sahitya Kulkarni
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, 07102
- Department of Biological Sciences, New Jersey Institute of Technology, Newark, NJ, 07102
- Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, NJ, 07102
- Department of Endodontics, Rutgers School of Dental Medicine, Newark, NJ, 07103
| | - Glennon Simmons
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, 07102
- Department of Biological Sciences, New Jersey Institute of Technology, Newark, NJ, 07102
- Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, NJ, 07102
- Department of Endodontics, Rutgers School of Dental Medicine, Newark, NJ, 07103
| | - Laura Osorno
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, 07102
- Department of Biological Sciences, New Jersey Institute of Technology, Newark, NJ, 07102
- Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, NJ, 07102
- Department of Endodontics, Rutgers School of Dental Medicine, Newark, NJ, 07103
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Affoo RH, Nellenbach C, Chomchai J, Rogus-Pulia N. The effects of endoscope placement in the hypopharynx on swallowing-related measures in healthy adults. Eur Arch Otorhinolaryngol 2023; 280:4979-4985. [PMID: 37414941 DOI: 10.1007/s00405-023-08114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE The purpose of this study was to determine whether transnasal passage of a flexible endoscope results in changes in salivary flow rate (SFR), spontaneous swallow frequency (SSF), and masticatory efficiency (ME) in healthy adults. METHODS Data were collected from 15 healthy adults, 20-63 years of age. SFR and SSF were measured at baseline, after endoscope insertion, and after endoscope removal. The Test of Masticating and Swallowing Solids was administered at baseline and while the endoscope was in the hypopharynx. A repeated measures ANOVA was used to determine the effect of endoscope insertion on SFR and SSF. A paired samples t-test was used to determine the effect of endoscope insertion on total mastication time and number of masticatory cycles required with a cracker bolus. Statistical significance was set at α = 0.05. RESULTS SFR was found to be significantly increased during endoscope placement in the hypopharynx (M = 0.471 g/min, SD = 0.175, p = 0.002) as well as following endoscope removal (M = 0.481 g/min, SD = 0.231, p = 0.004), as compared to baseline (M = 0.310 g/min, SD = 0.130). Total mastication time and number of masticatory cycles required with a cracker bolus were significantly decreased when the endoscope was present in the hypopharynx, as compared to baseline t(14) = 3.054, p = 0.009; t(14) = 3.250, p = 0.006, respectively. CONCLUSIONS Visualization of swallowing during FEES is an important method for objectively evaluating several anatomical and functional parameters of the pharynx and larynx. Insertion of the endoscope into the hypopharynx during FEES may stimulate salivary secretion and improve ME, which could influence interpretation of FEES and resulting clinical recommendations.
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Affiliation(s)
- Rebecca H Affoo
- School of Communication Sciences and Disorders, Faculty of Health, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College St., Halifax, NS, B3M 1N8, Canada.
- Central Michigan University, College of Health Professions, 1280 East Campus Dr., Mt. Pleasant, MI, 48859, USA.
| | - Ciara Nellenbach
- SCL Health, Platte Valley Medical Center, 1606 Prairie Center Pkwy, Suite 130, Brighton, CO, 80601, USA
| | - Joe Chomchai
- University of Michigan Health System, MyMichigan Physicians Group, Central Michigan University, 4851 E. Pickard Street, Suite 2700, Mt. Pleasant, MI, 48858, USA
| | - Nicole Rogus-Pulia
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-School of Medicine and Public Health, Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison GRECC (11G), Room D4240, Madison, WI, 53705, USA
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Rajeh MT. Gender Differences in Oral Health Knowledge and Practices Among Adults in Jeddah, Saudi Arabia. Clin Cosmet Investig Dent 2022; 14:235-244. [PMID: 35957700 PMCID: PMC9359402 DOI: 10.2147/ccide.s379171] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/29/2022] [Indexed: 02/02/2023] Open
Affiliation(s)
- Mona T Rajeh
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
- Correspondence: Mona T Rajeh, Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia, Tel +966 502500888, Email
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Bannwart LC, de Moraes Melo Neto CL, Goiato MC, Dos Santos DM, da Silva Paiva CA, de Araújo Moreno NV, da Silva EVF, de Magalhães Bertoz AP. Oral Health-Related Quality of Life, Dry Mouth Sensation, and Level of Anxiety in Elderly Patients Rehabilitated with New Removable Dentures. Eur J Dent 2021; 16:351-359. [PMID: 34814220 PMCID: PMC9339923 DOI: 10.1055/s-0041-1735796] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the influence of new complete dentures (CDs) and new removable partial dentures (RPDs) on oral health-related quality of life, dry mouth sensation, and anxiety level of their wearers. MATERIALS AND METHODS In total, 20 complete edentulous patients (in both arches) that needed to be rehabilitated with new CDs, and 20 partial edentulous patients (in both arches) that needed to be rehabilitated with new RPDs, were included in this study. Each patient must wear the same pair of CDs or RPDs for more than 5 years. Oral health-related quality of life, dry mouth sensation, and level of anxiety were assessed by using the following questionnaires: Geriatric Oral Health Assessment Index (GOHAI), VAS (Visual Analog Scale) Xerostomia Questionnaire, and State-Trait Anxiety Inventory (STAI). These questionnaires were applied before oral rehabilitation (initially initial time point) and 3 months after insertion of new dentures (end time point). STATISTICAL ANALYSIS For the results of STAI-State, STAI-Trait, and GOHAI, the Wilcoxon test was applied to compare the time points. For the results of the VAS xerostomia questionnaire, two-way repeated measures ANOVA (analysis of variance) was applied, followed by the Tukey test. The p-values lower than 0.05 were considered statistically significant. RESULTS /CONCLUSION: For both groups, it was observed that 3 months after the insertion of new removable dentures: (1) there was an increase in oral health-related quality of life; (2) there was a reduction in anxiety (trait anxiety and state anxiety); and (3) there was a perception of greater salivation.
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Affiliation(s)
- Lisiane Cristina Bannwart
- Department of Dental Materials and Prosthodontics, São Paulo State University, School of Dentistry, Araçatuba, São Paulo, Brazil.,Paulista University, School of Dentistry, Manaus, Amazonas, Brazil
| | | | - Marcelo Coelho Goiato
- Department of Dental Materials and Prosthodontics, São Paulo State University, School of Dentistry, Araçatuba, São Paulo, Brazil.,Oral Oncology Center, School of Dentistry, São Paulo State University, Araçatuba, São Paulo, Brazil
| | - Daniela Micheline Dos Santos
- Department of Dental Materials and Prosthodontics, São Paulo State University, School of Dentistry, Araçatuba, São Paulo, Brazil.,Oral Oncology Center, School of Dentistry, São Paulo State University, Araçatuba, São Paulo, Brazil
| | | | | | - Emily Vivianne Freitas da Silva
- Department of Dental Materials and Prosthodontics, São Paulo State University, School of Dentistry, Araçatuba, São Paulo, Brazil
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Islas-Granillo H, Casanova-Rosado JF, de la Rosa-Santillana R, Casanova-Rosado AJ, Islas-Zarazúa R, Márquez-Corona MDL, Rueda-Ibarra V, Jiménez-Gayosso SI, Navarrete-Hernández JDJ, Medina-Solís CE. Self-reported oral hygiene practices with emphasis on frequency of tooth brushing: A cross-sectional study of Mexican older adults aged 60 years or above. Medicine (Baltimore) 2020; 99:e21622. [PMID: 32898997 PMCID: PMC7478503 DOI: 10.1097/md.0000000000021622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The objective of the study was to characterize self-reported oral hygiene practices among Mexican older adults aged ≥60 years, and to measure the association between frequency of tooth brushing and a set of sociodemographic, socioeconomic, and dental variables.We conducted a cross-sectional study of 139 older adults aged ≥60 years in Pachuca, Mexico. A questionnaire and a clinical dental examination were administered to identify specific variables. We determined frequency of tooth brushing (or cleaning of dentures or prostheses) and use of toothpaste, mouthwash, and dental floss among respondents. Non-parametric testing was performed for statistical analysis and a multivariate logistic regression model was generated with Stata 11 software to determine frequency of tooth brushing.In our study sample, 53.2% of participants reported brushing their teeth at least once a day, 50.4% always using toothpaste, 16.5% using mouthwash and 3.6% using floss for their oral hygiene. In general, younger and female respondents used oral hygiene aids more than the others. Our multivariate model yielded an association (P < .05) between tooth brushing at least once daily and the following variables: having functional dentition (OR = 12.60), lacking health insurance (OR = 3.72), being retired/pensioned (OR = 4.50), and suffering from a chronic disease (OR = 0.43).The older adults in our sample exhibited deficient oral hygiene behaviors. The results suggest certain socioeconomic inequalities in oral health. The findings of this study should be considered when designing dental care instructions for older adults.
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Affiliation(s)
- Horacio Islas-Granillo
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca
| | | | | | | | - Rosalina Islas-Zarazúa
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca
| | | | - Vicente Rueda-Ibarra
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca
| | | | | | - Carlo Eduardo Medina-Solís
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca
- Advanced Studies and Research Center in Dentistry "Dr. Keisaburo Miyata" of Faculty of Dentistry at Autonomous University State of Mexico, Toluca, Mexico
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Wu CP, Xu YJ, Wang TG, Ku SC, Chan DC, Lee JJ, Wei YC, Hsiao TY, Chen CCH. Effects of a swallowing and oral care intervention for patients following endotracheal extubation: a pre- and post-intervention study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:350. [PMID: 31706360 PMCID: PMC6842457 DOI: 10.1186/s13054-019-2623-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/23/2019] [Indexed: 01/17/2023]
Abstract
Background For patients who survive a critical illness and have their oral endotracheal tube removed, dysphagia is highly prevalent, and without intervention, it may persist far beyond hospital discharge. This pre- and post-intervention study with historical controls tested the effects of a swallowing and oral care (SOC) intervention on patients’ time to resume oral intake and salivary flow following endotracheal extubation. Methods The sample comprised intensive care unit patients (≥ 50 years) successfully extubated after ≥ 48 h endotracheal intubation. Participants who received usual care (controls, n = 117) were recruited before 2015, and those who received usual care plus the intervention (n = 54) were enrolled after 2015. After extubation, all participants were assessed by a blinded nurse for daily intake status (21 days) and whole-mouth unstimulated salivary flow (2, 7, 14 days). The intervention group received the nurse-administered SOC intervention, comprising toothbrushing/salivary gland massage, oral motor exercise, and safe-swallowing education daily for 14 days or until hospital discharge. Results The intervention group received 8.3 ± 4.2 days of SOC intervention, taking 15.4 min daily with no reported adverse event (coughing, wet voice, or decreased oxygen saturation) during and immediately after intervention. Participants who received the intervention were significantly more likely than controls to resume total oral intake after extubation (aHR 1.77, 95% CI 1.08–2.91). Stratified by age group, older participants (≥ 65 years) in the SOC group were 2.47-fold more likely than their younger counterparts to resume total oral intake (aHR 2.47, 95% CI 1.31–4.67). The SOC group also had significantly higher salivary flows 14 days following extubation (β = 0.67, 95% CI 0.29–1.06). Conclusions The nurse-administered SOC is safe and effective, with greater odds of patients’ resuming total oral intake and increased salivary flows 14 days following endotracheal extubation. Age matters with SOC; it more effectively helped participants ≥ 65 years old resume total oral intake postextubation. Trial registration NCT02334774, registered on January 08, 2015
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Affiliation(s)
- Chung-Pei Wu
- Department of Nursing, National Taiwan University Hospital and National Taiwan University College of Medicine, 1, Jen-Ai Rd., Section 1, Taipei, Taiwan, Republic of China, 100
| | - Yu-Juan Xu
- Department of Nursing, National Taiwan University Hospital and National Taiwan University College of Medicine, 1, Jen-Ai Rd., Section 1, Taipei, Taiwan, Republic of China, 100
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 1, Jen-Ai Rd., Section 1, Taipei, Taiwan, Republic of China, 100.
| | - Ding-Cheng Chan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 1, Jen-Ai Rd., Section 1, Taipei, Taiwan, Republic of China, 100.,Department of Geriatrics and Gerontology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China.,Superintendent's Office, National Taiwan University Hospital Zhu-Dong Branch, Hsinchu, Taiwan, Republic of China
| | - Jang-Jaer Lee
- Department of Dentistry, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China
| | - Yu-Chung Wei
- Department of Statistics, Feng Chia University, Taichung, Taiwan, Republic of China
| | - Tzu-Yu Hsiao
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China
| | - Cheryl Chia-Hui Chen
- Department of Nursing, National Taiwan University Hospital and National Taiwan University College of Medicine, 1, Jen-Ai Rd., Section 1, Taipei, Taiwan, Republic of China, 100.
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