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

Abstract

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.

Oral hygiene aspects in a study of children and young adults with the congenital and childhood forms of myotonic dystrophy type 1

“…Individuals with DM1 who have poor OH should be identified and receive extra prophylactic dental care. DM1 is a progressive disease with a high risk of developing cardiac disease, respiratory dysfunction, and dysphagia and the importance of a healthy mouth is therefore of extra importance (Sjögren et al 2008). In addition, there are certain risks related to general anesthesia (Rogers & Clyburn 2004), which makes preventive oral care highly justified in patients who will require some kind of sedation in connection with dental treatment.…”

Oral Hygiene Reduces the Mortality from Aspiration Pneumonia in Frail Elders

“…Van der Mareel-Wiernik et al recommended tooth brushing after each meal, cleaning removable prostheses once a day, and professional oral health care once a week as the best regimen to reduce the incidence of aspiration pneumonia (van der MaarelWierink et al 2013). A systematic review concluded from 4 RCTs that 1 in 10 deaths from pneumonia in elderly nursing home residents may be prevented by improving oral hygiene (Sjogren et al 2008). …”

Oral Health- Related Quality of Life Assessed in Adults: Integrative Review

“…Para além disso, constituem, muitas vezes, a evidência primária de doenças sistémicas, nomeadamente em casos de diabetes ou HIV/SIDA (Griffin et al,2012;Petersen, Bourgeois, Bratthall, Ogawa, Estupinan-Day, & Ndiaye, 2005). Para além de que, melhores cuidados de higiene oral parecem prevenir infeções respiratórias e morte por pneumonia em idosos nos hospitais e lares (Sjögren, Nilsson, Forsell, Johansson, & Hoogstraate, 2008) e ainda a escovagem frequente de dentes pode estar associada a níveis baixos de doença cardiovascular (Oliveira, Watt, & Hamer, 2010).…”