At least once a week a patient will tell us that they only wear their teeth “for show” and not to eat because they don’t fit properly. And at least just as often, SLPs will recommend puree foods due to the patient being edentulous or “inadequate mastication”. Studies of mastication tell us that it is not necessarily the length of mastication or number of strokes or the pattern of mastication… but rather the granularity of the bolus that is important. There is also some good evidence that puree foods don’t contain the nutritional value of their non-pureed partners (not necessarily our scope but need to think about!) and that the sensory input that we gain from manipulating a bolus is important. All good reasons to think critically about the patient as a whole before deciding to recommend puree based solely on the presence or absence of teeth.
Then we have this nice lady. She has a few scattered teeth, is a little impulsive when eating, but her appetite is pretty good, weight is maintained, and no history or choking episodes. In the video, the first bolus is puree, the second is a soft solid. You can see that there is very little mastication happening with the soft solid, and that she pretty much swallows it whole (canned peaches, just fyi). If you only took the data gathered during the MBS, it might make sense to recommend puree. However, the lack of history of choking episodes, along with the further info that the patient had previously been on puree with really poor PO intake and refusal of meals and even weight loss, added together with the good airway protection we see here led our MBS Envision Cleveland SLP to recommend soft solid, with the further recommendation it be presented bite size (think IDDSI 6). Patient was quite happy to not be recommended back to puree, and the facility SLP was outstanding with her ability to collaborate with dietary to make this happen.
It can be really easy to default to a certain diet based solely on the data gained by the MBS… or during clinical evaluation, but the best plan of care is always going to come from consideration of all info we can get on the patient…. including how happy they are with that plan.
Unsafe Chewing: Choking and Other Risks: Lack of attention to chewing can set people up for dangerous consequences: aspiration or even choking. Screening and intervention can put them on a safer path.: The ASHA Leader: Vol 24, No 11