Abstract
Background and Objective:Tube feeding has been significantly associated with a higher rate of aspiration pneumonia that is mainly related to oral microorganisms and a reduced salivary flow. Thus, the difference in the mode of nutritional intake is expected to affect the oral environment, but this has not yet been fully clarified. The purpose of this study was to investigate, in tube-fed patients, changes in the oral moisture and the counts of microorganisms in saliva and tongue coating, which occur after oral ingestion resumption.Methods:Study participants were 7 tube-fed inpatients of the Niigata University Medical and Dental Hospital (72.7±8.5 years old) who received dysphagia rehabilitation at the Unit of Dysphagia Rehabilitation until oral ingestion resumption. Their oral health, swallowing, and nutrition status, oral mucosal moisture, amount of unstimulated saliva and the counts of microorganisms (total microorganisms, streptococci, Candida) in saliva and tongue coating were investigated and compared before and after the recommencement of oral intake.Results:Tongue coating, choking, oral mucosal moisture and amount of unstimulated saliva were improved significantly after resumption of oral ingestion. The other investigated parameters did not significantly change, except for the streptococci in tongue coating, which significantly increased 1 week after oral ingestion recommencement, but decreased thereafter.Conclusion:After oral intake resumption, oral mucosal moisture and amount of unstimulated saliva were improved. However, because of a transitory increase in the counts of streptococci with oral ingestion recommencement, it is important to appropriately manage oral hygiene in these patients, according to the changes in their intraoral microbiota.
Highlights
In a rapidly aging society, pneumonia, a common infection in the elderly, is a serious disease leading to high hospitalization and mortality rates [1]; in Japan, pneumonia has been reported as the third cause of death in 2011 [2]
About 60 percent of the hospitalized pneumonia patients suffer from aspiration pneumonia [5], which is mainly associated with microorganisms that colonize the human oral cavity [4, 6, 7]
One category in Tsukada et al screening sheet, “Presence of dentures” with the three levels: “Upper denture present”, “Lower denture present”, “No dentures”, did not fit to the newly introduced score system, and in this study, the presence or absence of dentures was investigated and recorded on a separate sheet at the initial visit, together with other information on the subject condition that was retrieved from the patient records on each investigation day: the body temperature, activities of daily living (ADL) and Japan Coma Scale (JCS)
Summary
In a rapidly aging society, pneumonia, a common infection in the elderly, is a serious disease leading to high hospitalization and mortality rates [1]; in Japan, pneumonia has been reported as the third cause of death in 2011 [2]. About 60 percent of the hospitalized pneumonia patients suffer from aspiration pneumonia [5], which is mainly associated with microorganisms that colonize the human oral cavity [4, 6, 7]. Both medical and dental staffs that provide care to older adults have been concerned about the consequences of dysphagia and recognize the importance of a good oral hygiene and oral health care in the prevention of aspiration pneumonia [8 - 13]. The purpose of this study was to investigate, in tube-fed patients, changes in the oral moisture and the counts of microorganisms in saliva and tongue coating, which occur after oral ingestion resumption
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