Oral manifestations of tube fed patients and management of patient

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Craig Elice Date: 5/07/2010
Article title: Dental Care for children fed by tube: a critical review
Author(s): Dyment et al.
Journal: Spec Care Dent
Month, Year: 1999:19 220-4
Major topic: Oral manifestations of tube fed patients and management of patient.
Type of Article: Literature review
Purpose: This article provides a literature review to describe oral signs of patients being tube fed and the management of these patients in terms of calculus build-up, caries, oral hypersensitivity, and risks of pneumonia.
Overview: Calculus: Review of literature indicates that there is no significant difference in terms of plaque formation of children on a feeding tube and those who eat via the oral route, yet there was a significant increase in calculus formation in the tube fed children. Another study revealed that despite daily hygiene practices, calculus build up was still greater in the tube fed sample Caries rates have not been studied. The pH of the saliva was greater in oral fed group than in tube fed group when given a sucrose and carbohydrate drink. The tube fed group had lower counts of strep, lactobacillus, and filmentous bacteria. Perio disease has not been studied. Dental erosion related to Gastro-esophageal reflux is not common because of the possibility of calculus protecting the teeth. However, GER is common in children fed by a tube as well as with patients less than 40 years of age with severe central nervous system dysfunction Oral hypersensitivity often develops in children who are tube fed and thus a program of oral stimulation such as regular oral hygiene at home and dental care in the dental office. Relevance of oral health to general health: Many tube fed children have neuromuscular impairment which may compromise their protective airway reflexes. In this case, the patient is at increased risk of aspiration and pneumonia. It is believed that chronic poor oral hygiene, reduced salivary flow, and increased calculus can lead to increased numbers of anaerobic plaque which is implicated in pneumonia. The best prevention for pneumonia may be aggressive oral hygiene. Risks of dental treatment include aspiration and subsequent pneumonia. Prevention of aspiration during dental treatment include posturing patient by positioning the patient vertically if possible with the neck elongated to open the airway. Use of head restraints and moth-props may negate the patients ability to protect their airways. Use of low viscosity liquids like water are difficult for the neurologically challenged patient to tolerate. Water spray from ultrasonic scalers, handpieces, and air water syringes should be limited. Frequent breaks are advised
Summary: The goal of dental care is lower the pathogenic bacteria in secretions which could be aspirated and thus lead to pneumonia. The frequency of professional dental cleanings should be determined on a case by case basis and treatment goals should be limited to shorter more frequent visits to avoid fatigue. Optimal oral health may decrease the morbidity and mortality of tube fed patients due to aspiration pneumonia.
Assessment of article: Good article with common sense conclusions.