Oral Implications of Prescribed Oral Nutritional Supplements for Disease Related Malnutrition
Objectives: The objective of this research is to investigate the sugar content of commonly prescribed oral nutritional supplements (ONS), their potential for oral disease and implications this may have for dental practice.
Methods: The nutritional information of commonly prescribed oral nutritional supplements (HSE’s standard ONS products List A and List B, and NHS' first and second line ONS products) was obtained from the BNF and confirmed by the information supplied on manufacturer's website. A comparison was made between the sugar content of these.
A systematic review was also carried out in 5 databases (Medline, Embase, Web of Science Core Collection, Google Scholar) using the following search terms: “Dental health” “periodont*” “caries” “dental” “candida” AND “oral nutritional supplements”.
Results: The sugar content of ONS can be significant, with some of the more commonly prescribed supplements containing over 20g of sugar per serving.
2 studies were included in the qualitative systematic review. Both of the studies were in vitro studies. One study showed that the ONS drink had higher cariogenic potential than milk (higher acidogenicity). The other study showed that qualitative evaluation of microbial growth in different ONS showed that E. coli, S aureus and C. albicans all grew at room temperature (20° C) in dairy drinks and creams. C. albicans also grew in the juice which was milk protein-free and lipid-free.
Studies also showed that there may be a lack of communication between a patient's medical and dental team regarding the use of ONS and this may result in conflicting advice to patients
Conclusions: 1. The sugar content of ONS frequently prescribed for treatment of malnutrition can be high.
2. The long term use of ONS may be detrimental to a patient’s oral health and may increase their risk of oral/dental disease.
3. Dentists need to be aware if their patients are taking ONS and implement a preventative treatment plan if so.
4. There is a need for increased communication and collaboration between nutritionists or medical professionals involved in the prescription of ONS and dental health professionals.