Clinical Significance of Oral Care and Oral Management on the Treatment and Prevention of Aspiration Pneumonia in the Elderly: Evidences and Pitfalls

Abstract

Oral care and oral management are important for preventing aspiration pneumonia (ASP). The main pathology of ASP is microaspiration of oropharyngeal contents during night, swallowing rehabilitation must be necessary for the ASP treatment. However, swallowing rehabilitation cannot totally restore the normal swallowing function. Oral healthcare management should be initiated and continued in parallel with antibiotic treatment of ASP. Oral care helps to prevent aspiration pneumonia by reducing oral bacteria, while oral management helps by improving masticatory and rehabilitating functions. The efficacy of oral care for reducing the incidence of pneumonia has been clearly observed in untreated frail elderly patients, but not in well-cared elderly persons. It has been established that oral care is cyclically significant for the prevention of ASP in the elderly. However, oral problems are not the primary cause of ASP in the elderly. Although there is an amount of evidences of oral care for ASP prevention, there are some controversies of the clinical significance of oral care for ASP treatment.

Best Practice Recommendations for Geriatric Dysphagia Management with 5 Ws and 1H

“…Studies have shown that older adults have difficulty swallowing, especially solid food, and that patients unconsciously eliminate solid food from their diets and modify it by prolonging the meal time or consuming less. 71 ) We believe that if this is done under the supervision of a health professional, the effects reported as negative will disappear. In support of this, nutritional management guidelines also strongly recommend the use of dietary modifications to ensure adequate and balanced nutrition in older patients.…”

“…However, GER, the most common cause of ED, also affects the oral region. 71 ) The major oral symptom of GER is dental erosion. In addition, it can also cause tonsillitis, oral mucosa atrophy, glossitis, xerostomia, and dysgeusia.…”

“…105 , 106 ) Because sarcopenia plays a key role in frailty, we also recommended adopting the recommendations for SD in these patients, including increased physical activity, muscle strengthening exercises, oral and dental care, and nutritional rehabilitation. 71 , 74 , 105 )…”