Denture Wearing during Sleep Doubles the Risk of Pneumonia in the Very Elderly

Abstract

Poor oral health and hygiene are increasingly recognized as major risk factors for pneumonia among the elderly. To identify modifiable oral health–related risk factors, we prospectively investigated associations between a constellation of oral health behaviors and incident pneumonia in the community-living very elderly (i.e., 85 years of age or older). At baseline, 524 randomly selected seniors (228 men and 296 women; mean age, 87.8 years) were examined for oral health status and oral hygiene behaviors as well as medical assessment, including blood chemistry analysis, and followed up annually until first hospitalization for or death from pneumonia. During a 3-year follow-up period, 48 events associated with pneumonia (20 deaths and 28 acute hospitalizations) were identified. Among 453 denture wearers, 186 (40.8%) who wore their dentures during sleep were at higher risk for pneumonia than those who removed their dentures at night (log rank P = 0.021). In a multivariate Cox model, both perceived swallowing difficulties and overnight denture wearing were independently associated with an approximately 2.3-fold higher risk of the incidence of pneumonia (for perceived swallowing difficulties, hazard ratio [HR], 2.31; and 95% confidence interval [CI], 1.11–4.82; and for denture wearing during sleep, HR, 2.38; and 95% CI, 1.25–4.56), which was comparable with the HR attributable to cognitive impairment (HR, 2.15; 95% CI, 1.06–4.34), history of stroke (HR, 2.46; 95% CI, 1.13–5.35), and respiratory disease (HR, 2.25; 95% CI, 1.20–4.23). In addition, those who wore dentures during sleep were more likely to have tongue and denture plaque, gum inflammation, positive culture for Candida albicans, and higher levels of circulating interleukin-6 as compared with their counterparts. This study provided empirical evidence that denture wearing during sleep is associated not only with oral inflammatory and microbial burden but also with incident pneumonia, suggesting potential implications of oral hygiene programs for pneumonia prevention in the community.

CAD/CAM milled complete removable dental prostheses: An <i>in vitro</i> evaluation of biocompatibility, mechanical properties, and surface roughness

“…On the other hand, a negative effect of biocompatibility might counteract this effect due to a higher surface roughness. Accumulation of oral biofilm is a highly relevant risk factor in geriatric populations 28) , where the presence of oral bacteria may cause aspiration pneumonia 29) , especially when the dentures are worn during the night 30) . At this stage, a better or worse biocompatibility of the novel prepolymerized denture resins remains speculative.…”

Periodontitis: from microbial immune subversion to systemic inflammation

“…Despite limited research in this area, mixed infection with P. gingivalis and T. denticola in a mouse model of aspiration pneumonia has been shown to cause considerably higher inflammatory responses, impaired bacterial clearance and more severe lung pathology compared with single infection with either bacterium 142 . Importantly, the control of the oral microbial burden substantially decreases the incidence of aspiration pneumonia in frail elderly people 143,144 , which suggests a direct association between oral bacteria and lung pathology in susceptible individuals. These results warrant more basic studies to understand the mechanisms involved.…”

Oral health for an ageing population: the importance of a natural dentition in older adults

“…Sjøgren et al suggested that 10% of nursing-home deaths from aspiration pneumonia could be avoided by improving oral hygiene 21 . Wearing dentures at night is likewise associated with oral infections, high microbial load, and increased incidence of pneumonia 22 . Hence addressing neglected oral hygiene can become a major pre-occupation for elders dependent on care.…”