The four D’s – dentition, dental care, dysphagia and diet are intertwined. This seminar will build on our basic knowledge and delve deeper into the role of dentition in maintaining our patient’s health. What role does each tooth play in mastication? What disease processes wreak havoc on our patient’s dental health? Dental care or oral hygiene takes a toll on our patient’s health as well. Not only is dental care imperative for all individuals on our case load, but it is especially critical for individuals with specific diseases. We will discuss the impact of poor dental care on overall health. Individuals on our dysphagia caseloads have any combination of natural dentition, partial or full dentures or are edentulous. What role does dentition status and dysphagia play in diet selection? How does lack of dentition increase the patient’s risk of aspiration? Rather than continuing to use the guidelines for the National Dysphagia Diet, the IDDSI should be implemented in our facilities. We will discuss how these two diets compare, and how to educate our staff to recognize and/or test foods to ensure the diet and liquid standards are met. New products that match the IDDSI levels will be introduced and reviewed. Many times, the patient and/or family reject the diet modification recommendations. Some facilities offer waivers, which are not recognized by the courts. Better options we implement are the Shared Decision-Making Algorithm and The Care Planning for Resident Choice. Appropriate for SLP/SLPAs and OT/COTAs.