The impact of 0.2% chlorhexidine gel on oral health and the incidence of pneumonia amongst adults with profound complex neurodisability

Abstract

Aims: Investigate the effect of toothbrushing with 0.2% chlorhexidine gel on oral health and pneumonia amongst patients with a neurodisability who are fed via percutaneous endoscopic gastrostomy. Method:Forty-nine patients at the Royal Hospital for Neuro-disability were recruited to an observational study. Daily toothbrushing with 0.2% chlorhexidine gel was undertaken for 12 months by trained nursing staff. Plaque and gingival health were assessed every six weeks using the Simplified Debris Index and the Basic Periodontal Examination. The annual incidence and prevalence of episodes of pneumonia experienced by patients whilst using the chlorhexidine gel were compared to rates from the previous year.Results: Plaque levels and the proportion of patients with periodontal pocketing > 3.5 mm significantly reduced, P < .001, with chlorhexidine toothbrushing. Total number of pneumonia episodes (75-67), antibiotics administered (73-64), and radiographs taken (19 to 16) were lower in the year wherein chlorhexidine was employed, and hospitalisations dropped by 31% (16-11), but these reductions were not statistically significant. No adverse events were reported. Conclusion:Daily toothbrushing with 0.2% chlorhexidine undertaken by a trained and supported nursing staff was effective in improving oral health but did not significantly affect annual rates of pneumonia amongst patients.

Pneumonia and the role of dentistry on ICU Staff

“…However, as stated by Prasad et al 24 (2009), it is difficult to ascertain whether the significant improvement in oral hygiene found in their study was due to chlorhexidine use or the improved technique of the ward staff or, indeed, both factors combined.…”

Do adults with splenic dysfunction, splenectomy or congenital asplenia require antibiotic prophylaxis prior to dental extraction? A systematic review

“…For example, De Rossi and Glick 14 suggested considering 0.12 chlorhexidine mouthwash before dental procedures as this may help to reduce the risk of pneumonia. However, recent evidence found that daily tooth brushing with 0.2% chlorhexidine was effective in improving oral health but did not significantly affect the annual rates of pneumonia 30 …”

“…However, recent evidence found that daily tooth brushing with 0.2% chlorhexidine was effective in improving oral health but did not significantly affect the annual rates of pneumonia. 30 Only one review identified recommended antibiotic prophylaxis before dental extraction for people with splenic dysfunction, splenectomy or congenital asplenia but offered no conclusion regarding the actual need and effectiveness of antibiotic prophylaxis. Terezhalmy and Hall 26 supported prescribing antimicrobial agents before dental procedures that may induce bacteraemia to reduce the risk of sepsis due to the lack of evidence regarding the proper dental management of people with splenic dysfunction, splenectomy or congenital asplenia.…”