Dental health in children on Home Parenteral Nutrition

Introduction: Administration of Home Parenteral Nutrition (HPN) in adults is known to be associated with poor oral health1. Little is known about the incidence of dental problems in children who are on long term home parenteral nutrition. Aim: To determine the presence of dental problems in children who are on long term home parenteral nutrition. Methods: Long term HPN was defined as administration of HPN for a period of more than 3 months. Information about the duration of PN, methods of enteral feeding, breast and bottle feeding in infancy, frequency of dental visits, dental problems, frequency of brushing and use of tooth paste were collected by emails, questionnaires and telephone consultations. Results: Dental health on twenty five children who were on HPN were analysed. The age group of study population was 1-18 years with a median age of 5.5. The average duration of PN administration was 4.3 years. Just under half had oral feeding concomitantly. 76% of patients have had breast and bottle feeding in infancy. 56% of children reported dental problems. 28% had teeth staining, 8% had gum infection, 16% had teeth decay and delayed dentition. 96% of children brushed regularly and 68% reported using tooth paste. 64% visited dentist on 2-12 monthly intervals. Discussion: Concerns exist between poor oral hygiene and catheter related infection. 60% of adults on HPN are reported to have problems with oral health1. In England, 41-54% of children have tooth decay and 67% of children have non carious dental condition3. When compared to the above two, incidence of dental problems was lower in our study group. Micronutrient supplementation is known to improve oral inflammation4. Children on HPN are regularly monitored and supplemented with micronutrients and thereby deficiency is uncommon in them. This also could possibly explain the lesser incidence of dental problems on children who are on HPN. Conclusion: Children on HPN have better dental health when compared to national statistics on children and adults on HPN. Reference 1. Intestinal failure and home parenteral nutrition: Implications for oral health and dental care. Lee AM, Gabe SM, Nightingale JM, Burke M. Clin Nutr. 2012 Jun 22. 2. Oral health, dental prophylaxis and catheter related bloodstream infections in home parenteral nutrition patients: results of a UK survey and cohort study. Lee AM, Gabe SM, Nightingale JM, Burke M. Br Dent J. 2012 Jan 27;212(2):E4. 3. Children's dental health in England 2003 4. The influence of micronutrients on oral and general health B Willershausen, A Ross, M Försch, I Willershausen, Ph Mohaupt, A Callaway Eur J Med Res. 2011; 16(11): 514–518. Published online 2011 November 10. doi: 10.1186/2047 783X-16-11-514