The Association Between Oral Microorgansims and Aspiration Pneumonia in the Institutionalized Elderly: Review and Recommendations

Abstract

Aspiration pneumonia is a leading cause of illness and death in persons who reside in long-term-care facilities and, combined with the lack of proper oral health care and services, the risk of aspiration pneumonia rises. The purpose of this article is to review recent literature on oral hygiene and oral care in long-term-care facilities and report new findings regarding associated risks for aspiration pneumonia, as well as research on oral care and health outcomes. The PubMed MeSH database was utilized to direct a specific search by entering terms "aspiration pneumonia" and "oral hygiene" from 1970 to 2009, which yielded 34 articles. The Ovid and Google Scholar databases were utilized as well and provided no additional references for the two terms. A manual search of references from other articles, including three systematic reviews published over the past decade, provided additional information regarding oral microorganisms and respiratory pathogens, as well as investigations of oral care. Finally, a brief but comprehensive introductory review was organized regarding oral microorganisms, biofilm, periodontal disease, and pneumonia to establish a framework for discussion. Overall, studies suggest (1) an association between poor oral hygiene and respiratory pathogens, (2) a decrease in the incidence of respiratory complications when patients are provided chemical or mechanical interventions for improved oral care, (3) the complex nature of periodontal disease and aspiration pneumonia make direct connections between the two challenging, and (4) additional studies are warranted to determine adequate oral hygiene protocols for nursing home patients to further reduce the incidence of aspiration pneumonia.

Periodontitis is related to lung volumes and airflow limitation: a cross-sectional study

“…Besides hygiene issues in pneumonia and COPD, associations of oral microorganisms and pulmonary infections due to aspiration have been investigated [45]. Usually, aspiration pneumonia is related to lessvirulent bacteria, streptococci and anaerobes that reside in the upper airways or the gastrointestinal tract [45].…”

“…Usually, aspiration pneumonia is related to lessvirulent bacteria, streptococci and anaerobes that reside in the upper airways or the gastrointestinal tract [45].…”

The Effects of Two Lubricating Products In Elderly Individuals - A Pilot Study

“…Individuals with poor oral hygiene have been found to have an increased rate of upper respiratory tract infections, such as pneumonia [5]. Aspiration pneumonia is the second most common infection in elderly in nursing homes, which requires hospital treatment and has the highest mortality [6]. In a study of the risk factors, it was found that a lack of oral hygiene and swallowing difficulties had a significant relationship with pneumonia incidence [7].…”

“…In a study of the risk factors, it was found that a lack of oral hygiene and swallowing difficulties had a significant relationship with pneumonia incidence [7]. Frail, elderly people with impaired immune systems may aspirate usually harmless oral micro-flora as candida and these results in opportunistic infections [6]. In the last years lubricating products have been popular as a treatment against oral dryness.…”

Poor Oral Health as Risk Factor for Community-Acquired Pneumonia

“…Considerable evidence exists to support an association between dental plaque, poor oral health, and respiratory diseases such as bacterial pneumonia in frail older people, nursing home residents or nosocomial infections in critically ill patients submitted to mechanical ventilation [9][10][11][12]. Teeth or dentures have non-shedding surfaces on which oral biofilms (i.e.…”