Microbiological Analysis and Oral Prevention Protocol in Enteral Feeding Patients

Nutritional disturbs are common in patients with neurological disorders.  Objectives: to analyze the oral and oropharyngeal microflora of patients with neurological disorders and enteral nutrition. Methods: the surveyed group (GS), consisted of 15 patients with enteral feeding by gastrostomy tube or nasogastric tube and the control group (CG), consisted of 15 patients with normal diet by mouth.  It was collected saliva, supragingival and subgingival plaque, secretion of mucous (from buccal mucosa, floor of the mouth and tongue dorsum) and oropharyngeal secretions, which were inoculated on Sabouraud agar for isolation of yeasts and  MacConkey agar  for  isolation of  enteric  microorganisms.  An oral care protocol   was  established  for the GS, including dental scaling   monthly,  daily  tooth brushing  with toothpaste to control dental calculus, and  mouthrinse  based on chlorhexidine digluconate  0.12%  and  5% of xylitol.  Results: the  bacterial culture  showed  a high incidence of enteric  microorganisms (18%) and Candida albicans (98%) in GS, but the PCR showed about  21%  of samples positive  for P. intermedia, P.gingivalis,  Mollicutes and Tannerella forsythia in the same group, while in the GC the prevalence of these bacteria was higher (27%). The new routine performed in 8 patients of GS showed significant improvement in bleeding index(GBI) average, which declined by 15%  in the experimental group, after 6 months of the protocol use,  and the  Simplified  Oral  Hygiene Index (OHI-S) mean, decreased from 1.48 to 0.57 (60% reduction) in the same period. Conclusion: a protocol for oral health specific to neurological disorders patients with enteral feeding is necessary in order to reduce the mortality rate of this population by respiratory problems, caused by periodontal microorganisms.