**5. The role of the dentist in an interdisciplinary effort to manage oropharyngeal dysphagia**

Oropharyngeal dysphagia arises as a result of so many types of endogenous or exogenous injuries that affect, isolated or combined, the salivation, chewing, and swallowing mecha‐ nisms. Injuries in these mechanisms usually impair the physical and mental health and quality of life of individuals. Undoubtedly, successful management requires an interdisciplinary collaboration among health professionals, which need to promote an accurate diagnostic workup, promote effective therapeutic strategies, and formulate an adequate management strategy of dysphagic patients in cases where cure of that condition is not currently possible.

The dentist is a health professional that clinically evaluates the oral health of patients at frequent intervals. However, in most curriculums of dental schools, very little is presented and discussed about chewing and swallowing disturbances regarding the diagnosis, management, and treatment of these conditions. Moreover, nor is it strongly discussed about salivary gland dysfunction (hyposalivation) and its interrelation as an important risk factor for swallowing disorders. However, as dysphagia is affected by salivation, chewing, and swallowing distur‐ bances, it is clear to realize that the dentist can perform proper educational and clinical activities that might provide preventive approaches, fast and accurate diagnosis, and partici‐ pate in treatment decisions in a multidisciplinary health care team. Moreover, the dentist may be the health professional with whom patients feel comfortable in reporting their salivation, chewing, and swallowing disorders.

With regards to the role of the dentist, the maintenance of oral health conditions in healthy individuals or the restoration of an adequate oral health in those individuals where these conditions are unfavorable (such as presence of dental caries, periodontal disease, oral candidiasis) must be prioritized before or during the treatment of oropharyngeal dysphagia. In addition, due to the high prevalence of edentulism (especially in older individuals), the replacement of missing teeth should be provided through the use of dental implants or dentures. The control of oral infections is mandatory. The aspiration of the pathogenic bacteria populations (mostly gram-negative) by dysphagic patients is responsible for development of pneumonia, the worse consequence of dysphagia. In healthy oral conditions, oral biofilm is colonized by commensal microflora, which acts as a barrier against the colonization of respiratory pathogens. However, poor oral health conditions reduce that commensal micro‐ flora, allowing the colonization and growth of pathogenic bacteria populations. Concerning the management of dysphagia due to hyposalivation, the dentist must identify the underlying cause, minimize or eliminate the effect of the underlying cause and, therefore, its effect on dental health and quality of life. In the same way, the dentist must prevent, identify, and treat many dental occlusion, articular (temporomandibular) and neuromuscular diseases that promote parafunction of masticatory muscles. Maintenance of oral health is fundamental for hospitalized patients and its impact appears to be more significant in medically compromised or long-stay hospitalized patients. Hospital-based dentistry might play an important role in the delivery of oral health care to long-term hospital dysphagic patients with disabilities (such as traumatic and congenital anatomical abnormalities and neurological and neuromotor disorders) who are unable to receive their required dental care in their community practice settings. In patients with deglutive disorders promoted by the side-effects of the usual oncologic treatments (surgical, chemotherapy, and radiotherapy) the oral care programs aim to remove mucosal irritating factors, cleanse the oral mucosa, maintain the moisture of the lips and the oral cavity, relieve mucosal inflammation and prevent and treat the inflammation.

In this way, a policy of systematic evaluation of dysphagic patients by oral health profes‐ sionals is highly recommended, with routine assessment of oral health, improvement of oral hygiene, and appropriate treatment of diseases related to salivation, chewing, and swallowing mechanisms.
