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Implications of PEG-tube Feeding for Oral Health

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by Madison Chang on 27 November 2012

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Transcript of Implications of PEG-tube Feeding for Oral Health

PEG-tube feeding and oral health Definitions

Implications

Management

Case presentation

Conclusion Scope of Presentation Methods of providing artificial nutrition via the gastrointestinal tract

Nasogastric

Gastrostomy & Jejunostomy
Endoscopic, Radiological inserted What is Enteral Feeding? Percutaneous Endoscopic Gastrostomy

A surgical procedure to place a feeding tube inside the stomach through the skin under the guidance of an endoscope

Swallowing dysfunction and airway protection

Convenient and cosmetically acceptable What is a PEG? Low caries activity

Alterations to the oral indigenous microbiota

Excessive plaque and calculus build-up

Oral hypersensitivity Implications on Oral Health Gastrointestinal complication
Nausea & Vomiting
Diarrhoea
Constipation Aspiration pneumonia PEG site
Infection
Leakage/irritation
Buried bumper syndrome
Fistula Formation
Inadvertent removal Risks and complications Abundant calculus, low caries activity, oral hypersensitivity

Aspiration pneumonia

Oral health may have significant consequences in terms of general health

Education and oral care plans for PEG-tube feeding patients Summary Neuromuscular impairments compromise protective airway reflexes

Bacteroids, Porphyromonas and Fusobacterium species

20% to 30% of PEG-fed patients Oral health care Body should be vertically symmetrical with neutral head flexion

Frequent breaks

Ultrasonic scaler, handpieces and airwater syringes should be limited and for all procedures

High-and low volume suctioning -/+ gauze 79 years old

MH: COPD. AF. DM Type II. Hypertensive disease

PEG-inserted - Stricture of oesophagus due to GORD and severe HSV oesophagiti

EO: Independently mobile Patient Case: Mr M Questions Dicks JL, Banning JS. Evaluation of calculus accumulation in tube-fed, mentally handicapped patients: the effects of oral hygiene status. Spec Care in Dent 11:104-6, 1991

Finucane TE, Bynum JPW. Use of tube feeding to prevent aspiration pneumonia. Lancet 348:1421-4, 1996

Klein FK, Dicks JL. Evaluation of accumulation of calculus in tube-fed, mentally handicapped patients. J Am Dent Assoc 108:352-4, 1984

Langmore SE, Terpenning MS, Schork A, et al. Predicators of aspiration pneumonia: how important is dysphagia? Dysphagia 13:69-81, 1998.

Littleton NW, Carter CH, Kelley RT. Studies of oral health in persons nourished by stomache tube. II. Acidogenic properties and selected bacterial components of plaque material. Arch Oral Biol 12:601-9, 1967.

Pearce CB and Duncan HD. Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: its indications and limitations. References (cc) photo by medhead on Flickr Dr Juliet Gray
Dr Adrianne Scott
Vicky Youngson Acknowledgements
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