The Oral-Systemic Nexus in Artificial Nutrition: A Narrative Review of Periodontal Health, Biochemical Parameters, and Wound Healing Outcomes
Abstract
Background: Patients dependent on enteral or parenteral nutrition (EN/PN) present a complex clinical paradox, receiving life-sustaining macronutrients while remaining at high risk for significant morbidity, particularly impaired wound healing. This vulnerability extends beyond caloric provision to a confluence of factors, including a high prevalence of oral and periodontal disease, dysregulation of critical nutrients (e.g., zinc), and a persistent systemic inflammatory state. Aim: This narrative review synthesizes current evidence (2015-2024) on the interplay between oral health status, key laboratory parameters (inflammatory markers, albumin, zinc), and wound healing in adult patients receiving EN/PN, with added emphasis on health informatics and nursing roles in integrated care. Methods: A comprehensive search of PubMed, Scopus, and CINAHL databases was conducted. Studies examining periodontal status, levels of CRP, albumin, zinc, and wound healing metrics in EN/PN populations were thematically analyzed, alongside literature on digital health tools and nursing-led interventions. Results: Evidence reveals a vicious cycle: poor oral hygiene and active periodontitis contribute to a systemic inflammatory burden (elevated CRP), which, combined with common hypoalbuminemia and zinc deficiency in EN/PN patients, critically impairs proliferative wound healing phases. Oral infection acts as a persistent reservoir of inflammation, exacerbating nutrient depletion and creating a non-permissive environment for tissue repair. Health informatics systems and structured nursing protocols can enhance monitoring, interdisciplinary communication, and patient-specific interventions. Conclusion: Effective wound management in this population necessitates a transdisciplinary approach. Routine oral health assessment and intervention must be integrated into standard nutritional care protocols, supported by health informatics tools and nursing-led coordination, alongside vigilant monitoring and repletion of zinc and protein, to mitigate inflammation and support healing.
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Copyright (c) 2024 Aeshah Mudhaya Ahmed Madkhali, Sahli, Afrah Ali A, Tahreer Mohammed Naser Hefzy, Ibtisam Adwan Al-Nawmasi, Amnah Aqeel Alrashidi, Awatif Hamoud Najem Alsolmi, Obadiah Farg Albogami, Naifah Enad Quaid Al-enezi, Rabaa Warad Alenze, Joman Salem Alhawiti, Nawal Mesfer Almuraya, Salha Ahmed Saeed Alshehri
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