A Systematic Review of the Preventive Effect of Oral Hygiene on Pneumonia and Respiratory Tract Infection in Elderly People in Hospitals and Nursing Homes: Effect Estimates and Methodological Quality of Randomized Controlled Trials

Oral Care AB, Göteborg, Sweden.
Journal of the American Geriatrics Society (Impact Factor: 4.22). 10/2008; 56(11):2124-30. DOI: 10.1111/j.1532-5415.2008.01926.x
Source: PubMed

ABSTRACT The objective of this study was to investigate the preventive effect of oral hygiene on pneumonia and respiratory tract infection, focusing on elderly people in hospitals and nursing homes, by systematically reviewing effect estimates and methodological quality of randomized controlled trials (RCTs) and to provide an overview of additional clinical studies in this area. Literature searches were conducted in the Medline database, the Cochrane library databases, and by hand-searching reference lists. Included publications were analyzed for intervention (or topic) studied, main conclusions, strength of evidence, and study design. RCTs were further analyzed for effect magnitudes and methodological details. Absolute risk reductions (ARRs) and numbers needed to treat (NNTs) were calculated. Fifteen publications fulfilled the inclusion criteria. There was a wide variation in the design and quality of the studies included. The RCTs revealed positive preventive effects of oral hygiene on pneumonia and respiratory tract infection in hospitalized elderly people and elderly nursing home residents, with ARRs from 6.6% to 11.7% and NNTs from 8.6 to 15.3 individuals. The non-RCT studies contributed to inconclusive evidence on the association and correlation between oral hygiene and pneumonia or respiratory tract infection in elderly people. Mechanical oral hygiene has a preventive effect on mortality from pneumonia, and non-fatal pneumonia in hospitalized elderly people and elderly nursing home residents. Approximately one in 10 cases of death from pneumonia in elderly nursing home residents may be prevented by improving oral hygiene. Future research in this area should be focused on high-quality RCTs with appropriate sample size calculations.

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    • "The systematic review by Sjogren et al. (2008) reported positive preventive effects of oral hygiene on pneumonia and respiratory tract infection in hospitalized elderly people and nursing home residents with an absolute risk reduction from 6.6% to 11.7%. They calculated that mechanical oral hygiene could prevent approximately one in 10 cases of death from HAP. "
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    ABSTRACT: Abstract Aim: To critically appraise recent research into associations between periodontal disease and systemic diseases and conditions specifically respiratory disease, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer. Methods: A MEDLINE literature search of papers published between 2002 and April 2012 was conducted. Studies that included periodontitis as an exposure were identified. Cross-sectional epidemiological investigations on large samples, prospective studies and systematic reviews formed the basis of the narrative review. A threshold set for the identification of periodontitis was used to identify those studies that contributed to the conclusions of the review. Results: Many of the investigations were cross-sectional secondary analyses of existing data sets in particular the NHANES studies. There were a small number of systematic reviews and prospective studies. There was substantial variability in the definitions of exposure to periodontitis. A small number of studies met the threshold set for periodontitis and supported associations; however, in some of the chronic diseases there were no such studies. There was strong evidence from randomized controlled trials that interventions, which improve oral hygiene have positive effects on the prevention of nosocomial pneumonias. Conclusions: There was substantial heterogeneity in the definitions used to identify periodontitis and very few studies met a stringent threshold for periodontitis. Published evidence supports modest associations between periodontitis and some, although not all, of the diseases and conditions reviewed. There is a need to reach a consensus on what constitutes periodontitis for future studies of putative associations with systemic diseases.
    Journal of Periodontology 04/2013; 84(4 Suppl):S8-S19. DOI:10.1902/jop.2013.1340010 · 2.57 Impact Factor
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    • "Similarly, benefits from effective oral hygiene have also been documented for pneumonia in non ambulatory (Scannapieco 2006) or elderly patients (Sjogren et al. 2008). Therefore, oral health requires management during in-patient care. "
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    ABSTRACT: Poor oral health of hospitalized patients is associated with an increased risk of hospital-acquired infections and reduced life quality. To systematically review the evidence on oral health changes during hospitalization. Cochrane library, Medline, OldMedline, Embase and CINAHL without language restrictions. Observational longitudinal studies. DATA APPRAISAL AND SYNTHESIS METHODS: Two independent reviewers screened studies for inclusion, assessed the risk of bias and extracted data. Risk of bias was assessed using the Newcastle-Ottawa assessment scale. A narrative synthesis was conducted. Five before and after studies were included. The data suggest a deterioration in oral health following hospitalization with an increase in dental plaque accumulation and gingival inflammation and a deterioration in mucosal health. While before and after studies are at a general risk of bias, other specific study characteristics were judged to have a low risk of bias. However, methodological issues such as unvalidated outcome measures and the lack of assessor training limit the strength of the evidence. Hospitalization is associated with a deterioration in oral health, particularly in intubated patients.
    Journal Of Clinical Periodontology 04/2011; 38(7):628-36. DOI:10.1111/j.1600-051X.2011.01727.x · 3.61 Impact Factor
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    ABSTRACT: Tesis Univ. Granada. Departamento de Estomatología. Leída el 18 de dicimbre de 2009
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