Aspiration pneumonia is a major cause of morbidity and mortality among the elderly who are hospitalized or in nursing homes. Multiple risk factors for pneumonia have been identified, but no study has effectively compared the relative risk of factors in several different categories, including dysphagia. In this prospective outcomes study, 189 elderly subjects were recruited from the outpatient clinics, inpatient acute care wards, and the nursing home care center at the VA Medical Center in Ann Arbor, Michigan. They were given a variety of assessments to determine oropharyngeal and esophageal swallowing and feeding status, functional status, medical status, and oral/dental status. The subjects were followed for up to 4 years for an outcome of verified aspiration pneumonia. Bivariate analyses identified several factors as significantly associated with pneumonia. Logistic regression analyses then identified the significant predictors of aspiration pneumonia. The best predictors, in one or more groups of subjects, were dependent for feeding, dependent for oral care, number of decayed teeth, tube feeding, more than one medical diagnosis, number of medications, and smoking. The role that each of the significant predictors might play was described in relation to the pathogenesis of aspiration pneumonia. Dysphagia was concluded to be an important risk for aspiration pneumonia, but generally not sufficient to cause pneumonia unless other risk factors are present as well. A dependency upon others for feeding emerged as the dominant risk factor, with an odds ratio of 19.98 in a logistic regression model that excluded tube-fed patients.

The primary purpose of the present study was to compare the microbial profiles of the tongue dorsa of healthy subjects and subjects with halitosis by using culture-independent molecular methods. Our overall goal was to determine the bacterial diversity on the surface of the tongue dorsum as part of our ongoing efforts to identify all cultivable and not-yet-cultivated species of the oral cavity. Tongue dorsum scrapings were analyzed from healthy subjects with no complaints of halitosis and subjects with halitosis, defined as an organoleptic score of 2 or more and volatile sulfur compound levels greater than 200 ppb. 16S rRNA genes from DNA isolated from tongue dorsum scrapings were amplified by PCR with universally conserved bacterial primers and cloned into Escherichia coli. Typically, 50 to 100 clones were analyzed from each subject. Fifty-one strains isolated from the tongue dorsa of healthy subjects were also analyzed. Partial sequences of approximately 500 bases of cloned inserts from the 16S rRNA genes of isolates were compared with sequences of known species or phylotypes to determine species identity or closest relatives. Nearly complete sequences of about 1,500 bases were obtained for potentially novel species or phylotypes. In an analysis of approximately 750 clones, 92 different bacterial species were identified. About half of the clones were identified as phylotypes, of which 29 were novel to the tongue microbiota. Fifty-one of the 92 species or phylotypes were detected in more than one subject. Those species most associated with healthy subjects were Streptococcus salivarius, Rothia mucilaginosa, and an uncharacterized species of Eubacterium (strain FTB41). Streptococcus salivarius was the predominant species in healthy subjects, as it represented 12 to 40% of the total clones analyzed from each healthy subject. Overall, the predominant microbiota on the tongue dorsa of healthy subjects was different from that on the tongue dorsa of subjects with halitosis. Those species most associated with halitosis were Atopobium parvulum, a phylotype (clone BS095) of Dialister, Eubacterium sulci, a phylotype (clone DR034) of the uncultivated phylum TM7, Solobacterium moorei, and a phylotype (clone BW009) of Streptococcus. On the basis of our ongoing efforts to obtain full 16S rRNA sequences for all cultivable and not-yet-cultivated species that colonize the oral cavity, there are now over 600 species.Halitosis, or oral malodor, is a common complaint of up to one-third of the general population and a large concern for the many individuals whom it affects (6, 19). Halitosis can arise from a variety of sources including the sinuses, gastrointestinal tract, ingested food, lungs, and, most frequently, the oral cavity. Oral production of malodorous substances is most commonly associated with by-products of bacterial metabolic degradation and occurs on oral surfaces, in periodontal pockets, and especially on the dorsal tongue surface. These products result from microbial fermentation of proteins, peptides, and mucins fo...

Periodontal disease is perhaps the most common chronic infection in adults. Evidence has been accumulating for the past 30 years which indicates that almost all forms of periodontal disease are chronic but specific bacterial infections due to the overgrowth in the dental plaque of a finite number of mostly anaerobic species such as Porphyromonas gingivalis, Bacteroides forsythus, and Treponema denticola. The success of traditional debridement procedures and/or antimicrobial agents in improving periodontal health can be associated with the reduction in levels of these anaerobes in the dental plaque. These findings suggest that patients and clinicians have a choice in the treatment of this overgrowth, either a debridement and surgery approach or a debridement and antimicrobial treatment approach. However, the antimicrobial approach, while supported by a wealth of scientific evidence, goes contrary to centuries of dental teaching that states that periodontal disease results from a “dirty mouth.” If periodontal disease is demonstrated to be a risk factor for cardiovascular disease and stroke, it will be a modifiable risk factor since periodontal disease can be prevented and treated. Since the antimicrobial approach may be as effective as a surgical approach in the restoration and maintenance of a periodontally healthy dentition, this would give a cardiac or stroke patient and his or her physician a choice in the implementation of treatment seeking to improve the patient's periodontal condition so as to reduce and/or delay future cardiovascular events

The subgingival bacterial flora from 2 gingival sites was cultured and characterized monthly in twenty periodontitis-free women during pregnancy and again post-partum. Monthly plaque samples were also cultured in eleven age and disease matched non-pregnant women. Plaque was processed anaerobically on selective and nonselective media and the predominant colony types were characterized. A portion of each plaque sample was tested for bacterial uptake of Ci4-estradiol and C^-progesterone. Plasma levels of estrogens and progesterone were measured four times in each subject. The number of gingival bleeding sites, the Gingival Index and the Plaque Index were determined at each sampling period.In the second trimester there was a significant increase in gingivitis, the ratio of anaerobic to aerobic bacteria, and the proportional levels of Bacteroides melaninogenicus ss. intermedius. In the third trimester both gingivitis and the levels of B. melaninogenicus ss. mtermedius decreased. Plaque uptake of Ci4-steroids increased significantly during pregnancy and paralleled the plaque levels of B. melaninogenicus ss. intermedius. In the second trimester, recovery of B. melaninogenicus ss. intermedius was strongly correlated with plasma levels of estrogens and progesterone. No changes were observed in clinical parameters or the subgingival flora of non-pregnant subjects.Pregnancy and specifically steroid hormones appear capable of influencing the normal bacterial flora and inducing alterations in the subgingival ecology.

Dental plaque samples from (i) subjects with no apparent oral disease, (ii) mentally retarded subjects with periodontal disease, and (iii) subjects with active caries were collected in three transport media viz. a dithiothreitol poised balanced mineral salt solution designated as reduced transport fluid (RTF), VMG II, and modified Stuart medium (SBL). The samples were dispersed by sonic treatment, diluted in the respective medium in which they were collected, and cultured on MM10 sucrose agar. The efficiency of the transport media in the survival of dental plaque flora was determined by comparing the quantitative recovery (expressed as percentage of the initial viable count) from the specimens stored for various lengths of time. The data showed a great variation in the recovery of the oral bacterial flora from the plaque samples. VMG II and SBL served better than RTF as storage media for non-disease-associated dental plaque cultured under strict anaerobic conditions. Recoveries of bacteria from periodontal plaque specimens stored in RTF were higher than SBL and VMG II under identical conditions. The organisms present in the carious plaque samples appeared to survive much better in RTF and VMG II than in SBL as determined by conventional anaerobic culturing technique. However, VMG II showed a higher recovery of organisms from these specimens with an increase in the storage period, suggesting multiplication of the plaque flora. RTF did not allow the growth of oral bacterial flora under all experimental conditions. On the basis of the relative performance of these media it is suggested that RTF is a statisfactory medium for the transport of oral bacteria present in the samples.

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This study supports the significance of oral and dental factors while controlling for established medical risk factors in aspiration pneumonia incidence.

The prevalence of oral malodor is probably high in the United States, although precise epidemiological data are missing. The many thousands of individuals who experience oral malodor from the overgrowth of proteolytic, anaerobic bacteria on their tongue surfaces can be successfully treated by a regimen that includes tongue brushing, toothbrushing and possibly the usage of mouthrinses containing various agents. Several candidate mouthrinses containing essential oils (Listerine), ZnCl2, or an oil, water and cetylpyridum chloride mouthrinse have reduced the organoleptic scores of individuals with moderate levels of oral malodor in the absence of tongue brushing. Very few long-term data beyond 6 weeks of usage are available. Anecdotal evidence suggests that other agents such as chlorine dioxide may be helpful. These mouthrinses should be marketed as oral deodorants that are analogous in purpose to the usage of deodorant soaps to control and/or eliminate body malodors. In this way the mouthrinse could be considered as a cosmetic by the FDA, provided that there are data on the safety of the various ingredients in the mouthrinse. Mouthrinses containing zinc ions are able to reduce the levels of volatile sulfur compounds by converting these volatile compounds to non-volatile, and therefore, non-malodorous zinc sulfides, and this mode of action would appear to support a cosmetic claim.