Oral health care and aspiration pneumonia in frail older people

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A number of previous studies have highlighted the risk of poor oral health as a potential risk factor for aspirational pneumonia in frail older people. The aim of this review was to review the literature on oral health care interventions in frail older people and the effect on the incidence of aspiration pneumonia.

The authors searched PubMed, Web of Science, Cochrane Library, EMBASE and CINHAL  databases for eligible intervention studies.   Publications that considered hospitalized or institutionalized older people, who were not dependent on mechanical ventilation were eligible. Study quality was assessed independently by two authors

Five publications were included. Two studies showed that improvement of oral health care diminished the risk of developing aspiration pneumonia and the risk of dying from aspiration pneumonia directly. The three studies remaining showed that adequate oral health care decreased the amount of potential respiratory pathogens and suggested a reduction in the risk of aspiration pneumonia by improving the swallowing reflex and cough reflex sensitivity.

The authors concluded

According to the results of the current systematic literature review oral health care, consisting of tooth brushing after each meal, cleaning dentures once a day, and professional oral health care once a week, seems the best intervention to reduce the incidence of aspiration pneumonia.

van der Maarel-Wierink, C. D., Vanobbergen, J. N., Bronkhorst, E. M., Schols, J. M. and de Baat, C. (2012), Oral health care and aspiration pneumonia in frail older people: a systematic literature review. Gerodontology. doi: 10.1111/j.1741-2358.2012.00637.x

Related reviews

van der Maarel-Wierink CD, Vanobbergen JN, Bronkhorst EM, Schols JM, de Baat C. Risk factors for aspiration pneumonia in frail older people: a systematic literature review. J Am Med Dir Assoc. 2011 Jun;12(5):344-54. Epub 2011 Mar 21. Review. PubMed PMID: 21450240.

Pace CC, McCullough GH. The association between oral microorgansims and aspiration pneumonia in the institutionalized elderly: review and recommendations. Dysphagia. 2010 Dec;25(4):307-22. Epub 2010 Sep 8. Review. PubMed PMID: 20824288.

Azarpazhooh A, Leake JL. Systematic review of the association between respiratory diseases and oral health. J Periodontol. 2006 Sep;77(9):1465-82. Review. PubMed PMID: 16945022.




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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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