Cariogenic Potential of Oral Nutritional Supplements in Elders

Objectives: Geriatric and cancer patients receive carbohydrate-containing oral nutritional supplements (ONS) as a balanced meal and/ or in-between-meals (1-7 times day) to prevent and treat malnutrition. This study aimed to show the cariogenic potential of over-the-counter ONS on enamel by in vivo pH telemetry.
Methods: This study received ethics approval (KEK-ZH-No. Stv 02/14).
Cariogenic potential of ONS on enamel was tested using intraoral pH telemetry in 5 standardized test participants (age: >68y). The patients were healthy, with normal salivary flow. They were requested to refrain from performing oral hygiene for 3-7 days prior to testing. pH-measurements were made using an intraoral electrode for 30 minutes after consuming ONS. It was then compared with a control 10%-sugar solution (AUC-quotient). To confirm whether a product has a cariogenic potential, 4 tests per product in ≥2 different test participants were conducted as per the international criteria for tooth-friendly products. Cariogenic potential was considered if the critical pH for enamel was ≤5.7 and AUC at ≥40 µmol H⁺xmin/l. Descriptive statistical analysis was performed.

Results: All 12 ONS (energy content: 1.0-2.4 kcal/ml; 3 different manufacturers) were potentially cariogenic for enamel in at least 3 of 4 tests. Two products were as cariogenic as a 10%-sucrose solution. No differences were found for any of the studied parameters: the biofilm formed, participant, carbohydrate content, and product administration (liquid, milky solution, thickened).
Conclusions: Based on the findings of this study, ONS administered for the prevention and treatment of malnutrition are found to be cariogenic. Therefore, an in-depth analysis of the oral state is considered cardinal before administering these supplements to dependent and bedbound dentate elders. Awareness of ONS caries risk, in geriatric and oncologic patients is recommended so as to structure regular dental recalls to prevent the incidence of caries.