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: 4.57). 10/2008; 56(11):2124-30. DOI: 10.1111/j.1532-5415.2008.01926.x
Source: PubMed


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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    • "Several studies have demonstrated the importance of oral health care in the management of patients with OD at risk of AP[23], and recent reviews have concluded that mechanical oral hygiene has a preventive effect on mortality from pneumonia , and decreases the risk of nonfatal pneumonia in elderly patients[24,25]. An estimated 10 % of deaths from pneumonia in elderly nursing home residents would be prevented by improving oral hygiene[24]. Furthermore, another recent study found that early screening and intensified oral hygiene reduced the incidence of X-ray-verified pneumonia compared with the control group without intervention (7 % vs 28 %; p [ 0.01)[26 • ]. "
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    ABSTRACT: Oropharyngeal dysphagia (OD) is a very prevalent condition in patients with neurological disorders and in the elderly, and has been shown to play a key role in the pathophysiology of aspiration pneumonia (AP), a frequent and severe complication in patients with OD. The pathophysiology of AP includes three main elements: (1) OD with impaired safety of swallow, aspirations, and frequently, impaired cough reflex; (2) poor oral health and oropharyngeal colonization by respiratory pathogens; and (3) frailty with malnutrition and poor immunity. Respiratory infections and AP lead to readmissions and high mortality among patients at risk, and appropriate management is important to avoid these complications. We have developed a therapeutic intervention including early screening, assessment, and treatment of patients at risk of OD. Those with OD are further assessed and treated for nutritional deficiency, oral hygiene, and oral diseases. This will reduce complications and morbidity and mortality among these patients.
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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: 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.
    Full-text · Article · Apr 2013 · Journal of Periodontology
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    • "This study found a high rate of culture positivity in the oral and tracheal secretions from the SG even after the TB was removed. This finding suggests that oral flora mobility may result from established oral care practices, which has been previously reported by several authors.(1,13,15) In this study, strain resistance was assessed by antibiograms to identify pathogenic microorganisms in the oral flora that may be involved in oral infections and trigger ventilator-associated pneumonia (VAP). "
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    ABSTRACT: To evaluate the effectiveness of a tongue cleaner in the removal of tongue biofilm in mechanically ventilated patients. Tongue biofilm and tracheal secretion samples were collected from a total of 50 patients: 27 in the study group (SG) who were intubated or tracheostomized under assisted ventilation and treated with the tongue cleaner and 23 in the control group (CG) who did not undergo tongue cleaning. Oral and tracheal secretion cultures of the SG (initially and after 5 days) and the CG (at a single time-point) were performed to evaluate the changes in bacterial flora. The median age of the SG patients was 77 years (45-99 years), and that of the CG patients was 79 years (21-94 years). The length of hospital stay ranged from 17-1,370 days for the SG with a median stay of 425 days and from 4-240 days for the CG with a median stay of 120 days. No significant differences were found when the dental plaque indexes were compared between the SG and the CG. There was no correlation between the index and the length of hospital stay. The same bacterial flora was found in the dental plaque of 9 of the 27 SG patients before and after the tongue scraper was used for 5 days compared with the CG (p=0.683). Overall, 7 of the 27 SG patients had positive bacterial cultures for the same strains in both tongue biofilm and tracheal secretions compared with the CG (p=0.003). Significant similarities in strain resistance and susceptibility of the assessed microorganisms were observed between oral and tracheal microflora in 6/23 cases in the CG (p=0.006). The use of a tongue cleaner is effective at reducing tongue biofilm in patients on mechanical ventilation and facilitates oral hygiene interventions performed by caregivers.
    Full-text · Article · Mar 2013
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