Oral Health Status and Development of Ventilator-Associated Pneumonia: A Descriptive Study

Abstract

• Background Ventilator-associated pneumonia is a significant cause of morbidity and mortality and may be influenced by oral health. • Objective To describe the relationship between ventilator-associated pneumonia and oral health status, changes in oral health status during the first 7 days after intubation, and microbial colonization of the oropharynx and trachea. • Methods A total of 66 patients were enrolled within 24 hours of intubation and were followed up for up to 7 days. Data on oral health measures and the Clinical Pulmonary Infection Score (CPIS) were collected at baseline, day 4 (n = 37), and day 7 (n = 21). A regression model was used to predict risk of pneumonia at day 4. • ResultsDental plaque and oral organisms increased over time. Correlations were significant for baseline and day 4 dental plaque (P < .001), baseline salivary lactoferrin and day 4 plaque (P = .01), and lower salivary volume and higher day 4 CPIS (P = .02). Potential pathogens were identified in oral cultures for 6 patients before or at the same time as the appearance of the organisms in tracheal aspirates. Correlations were significant with day 4 CPIS for score on the Acute Physiology and Chronic Health Evaluation (APACHE) II (P = .007), day 4 salivary volume (P = .02), interaction of APACHE II score and day 1 CPIS (P<.001), and interaction of day 1 CPIS and plaque (P=.01). • Conclusions Higher dental plaque scores confer greater risk for ventilator-associated pneumonia, particularly for patients with greater severity of illness. Salivary volume and lactoferrin may affect the risk.

Microfloral Characterization of the Tongue Coating and Associated Risk for Pneumonia‐Related Health Problems in Institutionalized Older Adults

“…In addition, the rates of death due to pneumonia in Clusters A, B, C, and D were 17%, 60%, 50%, and 100%, respectively. Although the total number of deaths in our study period (23) was too small to show statistical significance, the rate of death due to pneumonia in Cluster A (17%) was markedly lower than those in the other clusters. Taken together, it is possible that pneumonia is less frequent in elderly persons with the oral microflorae belonging to Cluster A.…”

“…Low resting salivary flow rate is related to tongue coating, 22 and it is possible that tongue dryness followed by low salivary flow rate is indirectly linked to accumulation of tongue coating, as was discussed in a previous study. 23 Although the current resolution of this T-RFLP technique is insufficient to detect all species involved in the floral composition, this rough profile provides new insight into bacteriological examination and may help clarify the relationship between specific bacteria detected in routine tests and general health. Further development of the T-RFLP technique, including computer analysis of multiple T-RFLP patterns from different restriction enzymes, may sufficiently increase the resolution of this method to detect a larger number of bacterial species without compensatory methods.…”

The impact of hospitalization on dental plaque accumulation: an observational study

“…Of the five included studies, four reported data on dental plaque. Of these studies, three reported an increase in dental plaque (Fourrier et al 1998, Franklin et al 2000, Munro et al 2006. The fourth study (Prendergast et al 2009) did not find an increase but may have had limited discriminatory ability to show change.…”

Multicentered epidemiological study of factors associated with total bacterial count in the saliva of older people requiring nursing care

“…It is well-known that many of the pathogens associated with aspiration pneumonia are in the oral cavity, [1][2][3][4] and therefore, effective oral care aiming at controlling the number of oral bacterial flora has been regarded as an important strategy for prevention of aspiration pneumonia. 5 To date, there have been a number of studies examining the factors that can affect the oral bacterial flora, including those related to: (i) capacity to implement oral care, such as reduced cognitive function, 6 reduced activities of daily living 7,8 and level of independence of oral care 9 ; (ii) deterioration of oral environment, such as reduced oral function, 10 tube feeding 11 and amount of salivation 12 ; and (iii) oral status and dental diseases, such as periodontal disease, 13 dental caries 1 and denture use. 14 Accepted for publication 29 October 2015. Regarding the oral status, conservation of the remaining teeth in older people is known to be important to maintain normal masticatory and swallowing function, and nutritional status.…”