Tube feeding linked to poorer oral health in children: Study
Inflamed gums, tartar buildup, vomiting among issues youngsters encounter
Children with rare diseases who have a gastrostomy tube, a feeding tube inserted through the belly and into the stomach, tend to have more inflamed gums, tartar buildup, and vomiting than those without those tubes, a study found.
However, younger children with a gastrostomy tube had significantly fewer cavities than children of the same age in the control group.
In many rare diseases — such as AADC deficiency — muscle weakness can make eating and swallowing difficult. To ensure enough nutrition, patients may require a feeding tube, but weakened muscles in the mouth and reduced sensation can make it difficult to clear debris around the teeth.
This “increases the risk for caries and gum disease,” researchers wrote in “Oral health in children with rare diseases and gastrostomy tubes: A retrospective database cohort study,” which was published in Nutrition in Clinical Practice. Caries are cavities caused by bacteria and acid.
All participants with a feeding tube had oral hypersensitivity
Symptoms of AADC deficiency usually begin in early infancy and can range from mild to severe. Common symptoms include weak muscle tone, movement disorders such as frequent episodes of involuntary upward eye movement, and developmental delays. Feeding and swallowing difficulties are also frequent, which may lead to poor weight gain and growth in some infants.
In children who need a gastrostomy tube to ensure enough nutrition, not eating by mouth or chewing can change the mouth’s bacterial environment and decrease its acidity, which can lead to tartar — hardened plaque that forms on teeth — and inflammation of the gums.
However, “performing oral care in children with rare diseases and a [gastrostomy tube] may be difficult due to impaired oral motor control, in combination with involuntary biting and/or vomiting reflexes,” the researchers wrote.
In this study, a group of researchers in Sweden set out to investigate the oral health of children with rare diseases in the country. Their study included 2,470 children with rare diseases whose data was documented in a national database that registers facts and statistics on oral health and function. They were followed between 1995 and 2018.
Children with [gastrostomy tubes] exhibited poorer oral health than those without [gastrostomy tubes], except in the case of caries.
This included 974 children ages 3 to 6, 1,085 ages 7 to 12, and 411 ages 13 to 16. Most children (89%) were fed by mouth, while 263 (11%) needed a gastrostomy tube.
Gingivitis, or inflamed gums, was significantly more common in children with a gastrostomy tube than in those without (48% vs. 36%), a difference that was even more obvious in younger children ages 3 to 6 (51% vs. 18%).
Tartar was also significantly more common in children with a gastrostomy tube (26% vs. 6%), but caries were less frequent (8% vs. 20%). This difference was statistically significant for children ages 3 to 6 (7% vs. 15%) and ages 7 to 12 (7% vs. 16%).
All children with a gastrostomy tube had oral hypersensitivity, or increased sensitivity or discomfort in the mouth, compared with 4% of children fed orally. Parents of children with a gastrostomy tube also more often reported frequent vomiting (29% vs. 3%), which can expose the mouth and teeth to stomach acid.
“Children with [gastrostomy tubes] exhibited poorer oral health than those without [gastrostomy tubes], except in the case of caries,” the researchers wrote. Therefore, they concluded, “oral health information should be included in healthcare guidelines for these patients.”
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