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Title In Patients with Feeding Tubes, Dentists Should Consider Pre-Medicating to Reduce the Chances of Aspiration Pneumonia During Invasive Dental Treatment
Clinical Question In an adult patient with feeding tubes, does pre-medicating the patient prior to invasive dental treatment such as surgical procedures reduce infections and aid in healing?
Clinical Bottom Line At this time, there is no evidence in regarding pre-medication of a patient with feeding tubes aiming to reduce infections during invasive dental treatment. However, a review supports that patients with feeding tubes receive proper dental care.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 10765889Dyment/1999Children with feeding tubesNarrative Review
Key resultsPatients with feeding tubes often present with large amounts of calculus, decreased caries activity, oral hypersensitivity, and dental erosion caused by gastro-esophageal reflex. These oral manifestations will affect the patient’s general health. Recurrent pneumonia is a concern for tube-fed patients where complications arise from impaired protective airway reflexes. Frequent, professional cleaning will be helpful in reducing the bacteria count associated with pneumonia in the oropharyngeal secretions. Increased dental visits to control patient’s calculus levels also benefit the patient. Frequency of dental visits depends on individual patient case and their oral health needs.
Evidence Search ("Dental Care"[Mesh]) AND "Enteral Nutrition"[Mesh]
Comments on
The Evidence
Validity: The review is based on multiple studies based on the oral diseases seen in children who are tube-fed. Perspective: Since there is no evidence in regards to the outcome of an invasive dental treatment for a tube-fed patient, it is up to the care-provider to make a professional judgment as to whether pre-medicating is beneficial for their patients. A further consideration would be that of choosing the correct local anesthetic for a dental procedure of an intubated patient.
Applicability The subjects were children who were tube-fed and comparisons were between these subjects and non-intubated patients. Patient compliance, discomfort, and frequent visits could explain possible reduced dental visits. On the other hand, improved oral and general health may be reasons to recommend intervention for these patients. Regarding the pre-medication treatment of these patients, it is up to the provider dentist to make careful treatment choices of intubated patients for invasive dental procedures. Consultations with physician specialist and other health care providers such as oral surgeons are amongst available options for the provider dentist providing oral health care for these patients.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Periodontics) (Dental Hygiene)
Keywords Intubated patients, pre-medicating, patients on feeding tubes
ID# 2632
Date of submission: 03/22/2014spacer
E-mail ahmadm3@livemail.uthscsa.edu
Author Mariam Ahmad
Co-author(s) e-mail
Faculty mentor/Co-author Moshtagh R. Farokhi, DDS, MPH
Faculty mentor/Co-author e-mail farokhi@uthscsa.edu
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