[Dysphagia] denture fixatives

[kgoertz at paphr.sk.ca (Clarke-Goertz, Kim (PAPHR))]

Hi All, 
I had a gentleman in last week with a c/o dysphagia of recent weeks (mostly
on dry crumbly solids, and less frequently with liquids).  He has a hx of
colon cancer (mild chemo tx 7 years ago with no know recurrence) and mild
CVA 15 years ago.

He has a partial denture (Upper) that he finds very challenging to keep in
place.  He said it is because he does not have enough bone depth for the
denture to fit and suction securely (i.e., not a deep enough trench).  He
says he has tried every fixative known to man and currently uses polygrip.
He reportedly has tried some type of powder but that didn't work well. 
He tells me that he ends up swallowing some of the fixative regularly and
that it is messy for him to do.  He says he'll continue to do it himself and
doesn't require assistance from anyone else (i.e., his spouse).  He reports
that once the denture is in place (with the fixative) it doesn't move around
for the remainder of the day (so, there goes my ill-fitting dentures
hypothesis).
I encouraged him to revisit his dentist to see if there's anything s/he
could suggest.  He sounded as if he might do that but was not terribly
convincing.

As for the dysphagia, I came up with a couple of possible hypotheses:
1. xerostomia
he reported that his mouth is often dry.  I need to cross check his meds for
this as a side effect (which are atenylol, aspirin, tylenol ES and lipitor).
I encouraged him to stay well-hydrated with water throughout the day .
I may have him try the Benefiber tip Irene gave last week on the listserv.
I may also tell him about the Biotene and/or Sage products for oral
moisture.

2. LPR
although, he recently had a nasendoscopy which was normal (ENT has done 2
previous VF biopsies 7 years ago at which time VFs were red).  I did notice
intermittent mildly weak voice and fairly consistent throat clearing.
He does report a history of 'heartburn' which he has managed over the years
with OTC meds (e.g., TUMS) but says he hasn't taken anything for a while.
He rejected this hypothesis (LPR) and didn't feel he had this problem.

So, I am asking the group for input on diagnosis as well as management.
If you have any ideas re: fixatives please pass them on.
If you have any idea as to what I should do next with this gentleman, please
share.  I plan to discuss my hypotheses with his family doctor, but I'm not
sure where it will go from there, perhaps a GI work-up as well as revisit to
ENT (although he just saw him).

Thanks all,
Kim