Mealtime Partners, Inc.

Certain foods break down more easily than others. For example, meat will not break down in your mouth without our teeth tearing and grinding it into particles, however long you hold it there. Other foods, like some kinds of crackers, will dissolve without chewing, if they are held in the mouth. After a few minutes they will become liquidized as they mix with saliva.

Some people lack the ability to move their jaw laterally and only use an up and down jaw movement to break up food. This is inefficient and without the back teeth grinding food the particles are irregular in size and large lumps can be left. Additionally, if the tongue does not move from side to side in a controlled manner, food is not pushed onto the back teeth to be chewed. (If teeth are missing then chewing ability is reduced. Some people are able to "gum" normal food to a consistence that is appropriate for them to swallow while others who have missing teeth, cannot.)

As mentioned earlier, when providing food for individuals who lack the ability to self-feed, it is important to be sure that the texture of the food being offered is appropriate for their oral motor skills and that it will not increase their risk of choking. Jonathan Rosenfeld, a lawyer who represents people injured in nursing homes, draws attention to the importance of food texture to everyone who is at risk of aspiration or choking. In an article on his blog, he relates the story of a nursing home resident who choked to death on a tuna fish sandwich. This is a dramatic example, but nevertheless, important because it profoundly illustrates how important food texture is for safe eating.

Various foods can be misleading as to how safe they are. This is more significant if the person is not seated correctly and does not have a chin-tuck. A good exercise to go through to understand this concept is to eat pudding. Sit in a chair and take a spoonful of pudding into your mouth. Hold the pudding in your mouth and lean back in your chair into a relaxed position. The pudding will move to the back of your mouth in this position. Note how it moves freely in your mouth rather than being easily formed into a bolus. Clear your mouth and take another bite, this time while the pudding is in your mouth raise your chin. The pudding will trickle to the back of your mouth and then to your throat. It will create the feeling of gagging. This exercise illustrates that even with soft food that appears to be easy to eat, it isn’t necessarily easy to control once it is in your mouth. Think about how runny the second bite of pudding became in your mouth. Sweet food will produce more and more saliva and therefore the second, and following bites, will become runnier as more saliva is produced. Also, the addition of saliva reduces the strength of the flavor and thus the taste buds are less able to track where it is in the mouth. To reduce excessive saliva production it is helpful to eat something more savory alternately with sweet food.

Many people are able to eat a normal variety of foods if they are prepared appropriately for them. Meat and other solid foods should always be cut into small pieces rather than lumps. It is safer to offer three or four small pieces of meat than one big piece, even if it is easier and quicker to offer a big bite. On the other hand, many people are fed texture-controlled foods that have been chopped or blended instead of cut into small pieces. There is a significant change in the taste of foods when they are minced or blended. Meats, in particular, lose much of the flavor when they are broken into particles, they also lose much of their moisture and liquids must be added to blend them. (Of course, if a texture-controlled diet has been prescribed, pieces of food should not be offered!) If blended or chopped food is being offered, improving the flavor should be addressed so that the consumer still enjoys the flavor of the meal. The importance of food flavor is addressed in our January 2010 Newsletter Topic: Food Flavor.