Oral Health, Oral Microbiota, and Incidence of Stroke-Associated Pneumonia—A Prospective Observational Study

Abstract

Stroke-associated pneumonia is a major cause for poor outcomes in the post-acute phase after stroke. Several studies have suggested potential links between neglected oral health and pneumonia. Therefore, the aim of this prospective observational study was to investigate oral health and microbiota and incidence of pneumonia in patients consecutively admitted to a stroke unit with stroke-like symptoms. This study involved three investigation timepoints. The baseline investigation (within 24 h of admission) involved collection of demographic, neurological, and immunological data; dental examinations; and microbiological sampling (saliva and subgingival plaque). Further investigation timepoints at 48 or 120 h after baseline included collection of immunological data and microbiological sampling. Microbiological samples were analyzed by culture technique and by 16S rRNA amplicon sequencing. From the 99 patients included in this study, 57 were diagnosed with stroke and 42 were so-called stroke mimics. From 57 stroke patients, 8 (14%) developed pneumonia. Stroke-associated pneumonia was significantly associated with higher age, dysphagia, greater stroke severity, embolectomy, nasogastric tubes, and higher baseline C-reactive protein (CRP). There were trends toward higher incidence of pneumonia in patients with more missing teeth and worse oral hygiene. Microbiological analyses showed no relevant differences regarding microbial composition between the groups. However, there was a significant ecological shift over time in the pneumonia patients, probably due to antibiotic treatment. This prospective observational study investigating associations between neglected oral health and incidence of SAP encourages investigations in larger patient cohorts and implementation of oral hygiene programs in stroke units that may help reducing the incidence of stroke-associated pneumonia.

Effect of Low Amperage Electric Current on Staphylococcus Aureus—Strategy for Combating Bacterial Biofilms Formation on Dental Implants in Cystic Fibrosis Patients, In Vitro Study

“…A number of oral bacterial taxa can affect not only oral health but also contribute to the initiation and/or progression of certain types of inflammation in the respiratory tract of CF patients [ 11 , 17 , 18 ]. Poor oral health may affect lung function and increase the risk of bacterial pneumonia [ 17 ].…”

The Influence of Periodontal Diseases and the Stimulation of Saliva Secretion on the Course of the Acute Phase of Ischemic Stroke

“…A similar trend was observed by Cieplik et al, in a prospective study assessing the health and bacterial flora of the oral cavity of patients admitted to the stroke department. The researchers found that the incidence of pneumonia in patients with confirmed stroke was more frequent in patients with larger dental cavities and poorer oral hygiene [ 44 ].…”

Is an Oral Health Status a Predictor of Functional Improvement in Ischemic Stroke Patients Undergoing Comprehensive Rehabilitation Treatment?

“…The neurological status of all patients included in the study was confirmed by early brain imaging using CT or MRI in the stroke unit. Moreover, few clinically useful tests, i.e., BI, BBS, and FIM, widely used in international classification to measure disability and functioning, were applied [ 26 , 32 , 33 , 34 , 62 , 63 ]. Therefore, the disability that affects daily living activities and the potential functional improvement of patients undergoing a rehabilitation program could be assessed.…”

“…It must also be emphasized that knowledge concerning proper oral care in stroke patients that stay, e.g., at the rehabilitation centers and nursing home settings [ 25 ], is lacking. Some future research should focus on potential associations between diseases of the oral cavity and neglected oral hygiene [ 26 ]. Thus, more clinical studies are needed in the field to support medical professionals.…”