(1) To understand the use of sensitivity and specificity in detecting disease; (2) To understand the current evidence regarding clinical signs of aspiration.

Aspiration pneumonia is a leading cause of illness and death in persons who reside in long-term-care facilities and, combined with the lack of proper oral health care and services, the risk of aspiration pneumonia rises. The purpose of this article is to review recent literature on oral hygiene and oral care in long-term-care facilities and report new findings regarding associated risks for aspiration pneumonia, as well as research on oral care and health outcomes. The PubMed MeSH database was utilized to direct a specific search by entering terms "aspiration pneumonia" and "oral hygiene" from 1970 to 2009, which yielded 34 articles. The Ovid and Google Scholar databases were utilized as well and provided no additional references for the two terms. A manual search of references from other articles, including three systematic reviews published over the past decade, provided additional information regarding oral microorganisms and respiratory pathogens, as well as investigations of oral care. Finally, a brief but comprehensive introductory review was organized regarding oral microorganisms, biofilm, periodontal disease, and pneumonia to establish a framework for discussion. Overall, studies suggest (1) an association between poor oral hygiene and respiratory pathogens, (2) a decrease in the incidence of respiratory complications when patients are provided chemical or mechanical interventions for improved oral care, (3) the complex nature of periodontal disease and aspiration pneumonia make direct connections between the two challenging, and (4) additional studies are warranted to determine adequate oral hygiene protocols for nursing home patients to further reduce the incidence of aspiration pneumonia.

This study examined the effects of tracheostomy cuff deflation and one-way speaking valve placement on swallow physiology. Fourteen nonventilator-dependent patients completed videofluoroscopic swallow studies (VFSS) under three conditions: (1) cuff inflated, (2) cuff deflated, and (3) one-way valve in place. Four additional patients with cuffless tracheostomy tubes completed VFSS with and without the one-way valve in place. All swallows were analyzed for the severity of penetration/aspiration using an 8-point penetration-aspiration scale. Seven preselected swallow duration measures, extent of hyolaryngeal elevation and anterior excursion, and oropharyngeal residue were also determined. Scores on the penetration-aspiration scale were not significantly affected by cuff status, i.e., inflation or deflation. However, one-way valve placement significantly reduced scores on the penetration-aspiration scale for the liquid bolus. Patients who are unable to tolerate thin liquids may be able to safely take thin liquids when the valve is in place. However, one-way valve placement may not be beneficial for all patients. Clinicians who complete VFSS with tracheostomized patients should include several bolus presentations with a one-way speaking valve in place before making any decisions regarding the use of the valve as a means to reduce aspiration.

The purpose of this investigation was to determine the utility of clinical swallowing examination (CSE) measures for detecting aspiration as defined by videofluoroscopic swallowing examination (VFSE). This study, involving 165 participants, is a follow-up to a previously published investigation of 60 participants. Findings are compared with that investigation as well as with other research on CSEs. The results suggest that clinicians can make an accurate judgment of the occurrence of aspiration in most poststroke patients. However, ruling out aspiration when it is absent appears more problematic. More work needs to be done if data collected from noninstrumented examinations are to be strongly predictive of the presence and absence of aspiration on VFSE. At present, there are no data to suggest that CSEs can be used to quantify aspiration or make adequate recommendations regarding patient care.