Influence of the oral mucosa condition on the nutritional status of children with neurological impairment in Varna

Introduction : The assessment of the causes for malnutrition in children with neurological impairment (NI) in Bulgaria is  challenging due to the heterogeneity of the leading diagnosis. In the case of soreness of the oral mucosa due to inflammatory processes or mechanical irritation, children experience discomfort and this disrupts the normal course of chewing. So far, no association between undernutrition in children with NI and the condition of the oral mucosa has been examined in Bulgaria. Aim : The aim of this article is to evaluate the condition of the oral mucosa and its relationship to the nutritional status of children with NI. Material s and Methods : About 54 patients with NI were recruited for the study, which took place between April and October 2017. Twenty-five of them lived in family settings and 29 in residential care (RC) in Varna, Bulgaria. After briefing all participants (family members and caretakers) about the nature and meaning of the study, they took an informed participation in an intraoral examination of the oral cavity of their children. The nutritional status was assessed by anthropometric measurements. The study was approved by the Medical Ethical Committee of the Medical University of Varna. Results: The examination of the condition of the oral mucosa of children with NI revealed various signs of inflammatory changes of the mucous membranes, showing that among 66% of the recruited patients redness and swelling, lining on the back of the tongue, etc. were observed. There were various inflammatory changes observed in the oral mucosa in 89.28% of the cases who are raised in the RC and 40% in those living in family settings. The differences in the prevalence of inflammatory changes of the oral mucosa between the two groups of patients was statistically significant ( X 2 = 16.13, p = 0.001). Statistically significant was also the relationship between the oral mucosal status and the status of malnutrition, as estimated by anthropometric indicators such as weight-for-age, height-for-age and subscapular skin fold thickness following the World Health Organization criteria and standards (2006, 2007). Discussion: Many factors affect malnutrition in children with NI. One of the factors is the condition of the oral mucosa. Its improvement would most probably increase the ability of this vulnerable group of children to eat foods of varying composition and consistency, which would have a positive effect on their nutritional status. Conclusion: Our study shows a direct link between inflamed and painful oral mucosa and malnutrition in children with NI.