Oral Health Status of Adult Dysphagic Patients That Undergo Endoscopic Gastrostomy for Long Term Enteral Feeding

Abstract

Background: Endoscopic Gastrostomy (PEG) is required to maintain a feeding route when neurological or cancer dysphagia impact oral intake. This study aimed to evaluate the oral health and oral changes of PEG-patients without oral feeding for three months. Methods: Prospective observational study, with a PEG-patients convenience sample. Data were obtained before PEG (T0) and 3 months after gastrostomy (T1). Initial oral hygiene habits were collected through a questionnaire. Intra-oral evaluation was performed using: Plaque Index (IP), Gingival Index (IG), Decayed, Missing and Filled Teeth Index (DMF), Community Periodontal Index (CPI), and Attachment Loss (AL). T0 and T1 were compared to evaluate oral health evolution. Results: Thirty-nine patients aged 65.3 ± 17.4 years were included. Initial (T0) oral health was worse than expectable. Between assessments period, oral indexes suffered a general deterioration with statistical relevance to the DMF. The frequency of deep periodontal pockets and attachment loss remained stable. Conclusions: PEG-patients presented poor oral health and insufficient oral hygiene habits, even before gastrostomy. After three months of PEG feeding, oral health suffered a general deterioration. This outcome was probably associated with the absence of oral feeding activity, which is beneficial to oral homeostasis, and further reduced oral hygiene. Improved oral daily care and dental appointments should become part of the PEG-patients follow-up.

Assessment of Oral Health in Long-Term Enteral and Parenteral Nutrition Patients: Significant Aspects of Nursing Care

“…In a study carried out at the Outpatient Clinic of Artificial Nutrition in Portugal, patients showed poor oral health before the start of feeding by gastrostomy. During three months of exclusive enteral feeding via percutaneous endoscopic gastrostomy (PEG), all studied oral health indicators, such as mucosal, gingival, dental, and plaque status, deteriorated [ 6 ].…”

“…The profile of patients requiring enteral and parenteral nutrition has changed over the years. They tend to be older patients, over 65 years of age, and have serious comorbidities [ 6 , 17 ]. Aging and severe comorbidities affect oral self-care [ 18 ].…”

“…This condition has been observed by Lopes et al where 30 out of 40 patients on enteral feeding through PEG experienced difficulties with oral self-care and were dependent on caregiver support for oral care. Considering these changes, the approach to dental care for elderly patients requiring long-term nutritional therapy should take into consideration their health status and self-care capacity [ 6 ].…”

“…The omission of the natural route of food intake not only deprives the patient of the pleasure of eating but is also associated with the risk of complications and accompanying unpleasant sensations. Impaired masticatory function, regardless of the cause, is an important factor causing oral health problems, and patients, as well as their caregivers, are often unaware of the importance of oral health as an important component of overall health [ 6 ]. Lack of regular exogenous mechanical (chewing food) or chemical (taste) stimulation reduces saliva secretion, which leads to prolonged carbohydrate removal, accumulation of food debris and plaque, decrease in saliva pH, and dysbiosis [ 7 ].…”