Removable Denture Wearing as a Risk Predictor for Pneumonia Incidence and Time to Event in Older Adults

Abstract

Introduction: Older adults are more susceptible to a common respiratory infection: pneumonia. Nearly 1 million older adults per year are hospitalized for community-acquired pneumonia in the United States. Objective: To examine whether wearing removable dentures are associated with an increased risk of pneumonia incidence in a geriatric population. Methods: We conducted a retrospective cohort study among patients >65 y of age within a large academic health system (University of Rochester Medical Center). The medical and dental electronic records from 2010 to 2018 were reviewed and used for data collection. The exposure was removable denture wearing. The main outcome variables were the incidence of pneumonia and time to event of pneumonia. A Cox proportional hazards regression was used to examine the association between pneumonia onset and wearing removable dentures, adjusting for demographics, socioeconomic status, and medical and dental conditions. Results: A total of 2,364 patients were included, with 1,189 (50.29%) in the denture-wearing group and 1,175 (49.70%) in the non–denture wearing group. The annual pneumonia incidence rate per 100,000 persons was 1,191 in the denture-wearing group and 128 per 100,000 persons in the non–denture wearing group, with a crude incidence rate ratio of 9.33 (95% CI, 5.41 to 18.81; P < 0.0001). The mean ± SD age of the pneumonia onset was 78.0 ± 10.0 and 78.6 ± 9.0 y among denture-wearing and nonwearing groups (P = 0.84). The time to event of pneumonia was associated with removable denture wearing (yes/no; hazard ratio, 7.68 [95% CI, 3.91 to 15.08]; P < 0.001) after adjusting for covariates. Conclusions: Wearing removable dentures was found to be a risk predictor for pneumonia incidence among the geriatric population even after accounting for other risk factors. Knowledge Transfer Statement: Wearing removable dentures was found to be a risk predictor of pneumonia incidence among older adults. Although the current study does not imply a causal relationship between denture wearing and pneumonia, clinicians and older patients could reference the study results when choosing dental prostheses to restore missing teeth.

Prevalence of respiratory pathogens colonizing on removable dental prostheses in healthy older adults: A systematic review and meta‐analysis

“…Some studies have reported an association between removable prosthesis-wearing or poor prosthesis hygiene and community-or nosocomial-acquired pneumonia. [4][5][6] The colonization of respiratory pathogens on prostheses may increase the risk of respiratory infections through aspiration from the oropharynx into the lower respiratory tract. 2 Three included studies in the present review found high detection rates of opportunistic respiratory pathogens isolated from removable prosthesis biofilm, ranging from 46.0% to 64.6%.…”

“…Some studies have reported an association between removable prosthesis‐wearing or poor prosthesis hygiene and community‐ or nosocomial‐acquired pneumonia 4–6 . The colonization of respiratory pathogens on prostheses may increase the risk of respiratory infections through aspiration from the oropharynx into the lower respiratory tract 2 .…”

“…also reported that infrequent prosthesis cleaning was significantly associated with the self‐reported incidence of pneumonia. A recent long‐term follow‐up study revealed that removable prosthesis‐wearing was associated with a 7‐fold higher risk of pneumonia compared to non‐prosthesis wearers 6 . Thus, the importance of proper removable prosthesis hygiene to minimize the risk of microbial contamination and colonization is critical not only for oral health but also for reducing the risk of respiratory infections and other life‐threatening opportunistic infections.…”

Anti-biofilm effectiveness of protocols for cleaning complete dentures in hospitalized patients: a randomized controlled trial

“…In this context, users of removable dentures, mostly elderly individuals, deserve special attention 4 , 5 since it was found that wearing these prostheses, especially during sleep, 6 is a risk predictor for the incidence of pneumonia in the geriatric population. 7 Even greater attention should be directed to hospitalized elderly people because the presence of oral and denture biofilm associated with compromised host immunity and the aspiration of the contents present in the oropharynx into the lower respiratory tract increases the risk of AP, especially 48 h after hospitalization. 8 Furthermore, the greater lack of autonomy also leads to less satisfactory cleaning of dentures during hospitalization.…”

Considering the Vulnerable Populations of Young and Old

“…While the incidence of complete edentulism is declining, many people are still completely or partially edentulous and wear prosthetic devices to replace the missing teeth. Using an 8-y retrospective longitudinal design, Alzamil et al (2021) measured the incidence and time to event of pneumonia in a population of independently living older people (65+ y) wearing and not wearing any type of removable dental prostheses ( n = ~2,300). Among other concerning findings, they report that pneumonia risk was significantly associated with use of dental prostheses and that those who wear dental prostheses have 6 times greater risk of contracting pneumonia than others who do not use dental prostheses.…”