Intestinal failure and home parenteral nutrition: implications for oral health and dental care.
OBJECTIVE
Background disease processes, medication and therapies in people with intestinal failure receiving home parenteral nutrition may affect their oral health. To inform oral health advice for this group a study of their oral health status was carried out.


METHODS
Fifty-two HPN outpatients recruited from specialised nutrition clinics at a national referral centre listed their medical and medication history, perceived oral health and dental treatment experience in a structured interview and underwent an oral health examination. Findings were compared with 2009 UK Adult Dental Health Survey data, using one-sample t tests.


RESULTS
Oral health of the HPN cohort was poorer than the UK norm; patients had more decay (p<0.001), fewer teeth (p<0.001) and fewer sound and untreated teeth (p=0.023) despite similar dental attendance. Hyperphagia, sip feeds, oral rehydration fluids and polypharmacy (in 96%) are identifiable risk factors for caries, xerostomia (in 81%) and thus oral infection risk (including oral candidiasis). Patients were experiencing current problems (60%) and psychological discomfort (56%) from poor oral health. The patient pathway does not include oral health information.


CONCLUSIONS
Dental teams should be aware of the management and prevention of HPN related complications with bisphosphonates, anticoagulant therapy, and parenteral antibiotic prophylaxis. HPN patients may benefit from increased awareness of their oral health risk factors.
Department of Oral and Maxillofacial Surgery, North West London Hospitals NHS Trust, SDO NHS Hillingdon, Wathford Road, Harrow HA1 3UJ, UK. alisonlee5@nhs.net
A M
AM
Lee
S M
SM
Gabe
J M
JM
Nightingale
M
M
Burke
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003731:Dental Caries / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications / Q000453:epidemiology / Q000209:etiology; D007410:Intestinal Diseases / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D007422:Intestines / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D009909:Oral Health; D009910:Oral Hygiene / Q000523:psychology; D016331:Parenteral Nutrition, Home / Q000009:adverse effects* / Q000523:psychology; D012306:Risk; D012649:Self Concept; D006113:United Kingdom / Q000453:epidemiology; D014987:Xerostomia / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult