Salivary Glands, 3 Pillars of Aspiration, Secretion Management

Salivary Glands do what

Produce Salvia

Saliva is made out of (4)

1. Water

2. Proteins

3. Enzymes

4. **Antibacterial Compounds: helps keeps us healthy/keeps mouth at a healthy microbiome

   1. Any kind of illness is starting to get attacked by saliva

   2. helps manage diseases

** Patients who do not have enough saliva often have bad oral hygiene (e.g., missing teeth, a lot of cavities. again, saliva keeps our mouth at a healthy microbiome.

Saliva and Swallowing

Saliva helps breaks down and form a cohesive bolus that is safe to swallow

→ aka breaks down food we eat so that we can form a bolus

DRY SWALLOW: aka swallowing at rest w/o food or liquid in your mouth (i.e. just swallowing your saliva)

→ Why would we ask patients to do this? to see if they have voluntary control over their swallow

→ why would we have a patient dry swallow between bites of food? Treatment for those with a lot of pharyngeal residue

• Take a bite of food → swallow→ dry swallow

3 major salivary Glands

salivary glands=small organs in our mouth that make saliva

1. Parotid Gland

2. Submandibular gland

3. sublingual gland

When our salivary glands Dysfunction

• usually means we are not producing enough saliva

• different medications can impact saliva production: allergy meds can dry up saliva, different medications for autoimmune disorders, lupus, rheumatoid arthritis, HIV/AID positive, cancer treatments (Chemo) can also dry up saliva/cause salivary dysfunction

Secretion Management- the WHY

• Oftentimes, not an overproduction issue, but patient not swallowing saliva.

• patient having trouble managing secretions can look like: drooling, choking, overproducing, or just not swallowing it.

• Possible Dxs that can lead to way too much secretions/difficulty managing them appropriately: ALS, Cerebral Palsy, Stroke, TBI

Secretion management- the HOW (3)

1. Pharmacological treatments:

   1. too much secretions/not swallowing it appropriately: expectorants, drying agents, etc.

2. Non-Pharmacological Treatments:

   1. Hydration, suctioning, postural drainage, chest PT

      1. Suction: Suction swabs (for oral care, used to brush teeth as well) and covered Yankauer (like the dentist one) connected to suction canister (connected to wall)

3. Initial management recommendations

3 Pillars of Bacterial Aspiration Pneumonia****

• Helps us understand the causes of Aspiration PNA & helps GUIDE recommendations for Patients

1. Serious Illness or Fraility ( Being Immunosuppressed):

   1. ex: renal transplant, cancer patient, really old patients, multiple comoribities (having COPD and Cancer), patients who are not ambulatory (i.e. have reduced physical mobility), oxygen dependent, acute illness)

   2. also just higher likelihood of getting PNA just sitting in a hospital

2. Impaired Laryngotracheal Protection

   1. AKA impaired airway protection AKA we are ASPIRATING

   2. want to look at the AMOUNT we are aspirating (e.g., are we grossly aspirating (a lot) or trace aspirating (a little)

   3. also want to look at frequency (how consistently is this happening?)

• Gross and high frequency increases risk of ASPIRATION PNA

• also good to know what they are aspirating (e.g., solids, liquids, or both)

  • helps guide treatment/strategies recommended (i.e., diet modification, etc).

3. Poor Oral Environmental Conditions:

   1. poor oral and oropharyngeal conditions increases bacterial load

   2. if a patient does not have adequate oral care, risk of aspiration PNA is high

Example- Low risk of developing Aspiration PNA

• if a patient is trace aspirating consistently, but are ambulatory (walking around), not immunocompromised, relatively healthy, good oral health,

• likelihood of developing PNA=pretty low

Example- High Risk of Developing Aspiration PNA

• if a patient is older with stage 4 CKD (Chronic kidney disease), is on Oxygen, had multiple pacemakers, has heart issues, and is trace aspirating consistently.

• Even though only aspirating small amounts, likelihood of developing PNA= HIGH

Aspiration Does not ALWAYS EQUAL PNA; there are risk predictors

just because they are aspirating, doesn’t mean we should necessarily modify their diet

Pneumonia “Risk” Predictor

• Poor Oral Health + No Aspiration + Normal Immunity= No PNA

• Poor Oral Health + Aspiration + Normal immunity= No PNA

• Poor Oral Health+ No Aspiration + Reduced Immunity= no PNA

• Good Oral Health + Aspiration + Normal Immunity= no PNA

• Good Oral Health + No Aspiration + Reduced Immunity = no PNA

• Good Oral Health + Aspiration + Reduced Immunity= LOW RISK of PNA**

• Poor Oral Health + Aspiration + Reduced Immunity= High Risk of PNA**

so basically, if you have good immunity and everything else is cooked, or if you have no aspiration and everything else is cooked, won’t get PNA. But if you have good oral health and everything else is cooked, will have a LOW risk of PNA. and if everything is cooked, well obviously you will get PNA