Professional Oral Healthcare Reduces Pneumonia Risk

A recent Canadian study found that residents of long-term care (LTC) facilities who received professional oral healthcare from dental hygienists were at reduced risk of nursing-home acquired pneumonia (NHAP). The prevention benefits were even greater when daily oral hygiene was implemented, either via self-care or provided by staff.¹

The researchers reviewed the literature to compare LTC residents with oral disease to nonLTC residents. They also compared professional oral healthcare services delivered in LTC homes vs independent- or assisted-living environments and nonprogram delivery.

Residents who received professional oral healthcare onsite in LTC produced better oral health and respiratory infection outcomes than those who didn’t receive the care, which consisted primarily of prophylactic services, sometimes combined with education.

Risk Factors

A lower respiratory tract infection that often occurs in residents of LTC facilities, NHAP is caused by viruses, fungi, or bacteria. And because such populations are typically rife with comorbidities, they’re vulnerable targets for increasingly virulent strains of such organisms.²

In 2017-2018 pneumonia accounted for 65% of emergency department visits, making it the leading cause for such trips to the hospital among older adults in Canada. It’s also reportedly the leading cause of death in LTC living situations.¹

Older adults are particularly vulnerable when it comes to pneumonia, which often develops due to aspiration. The risks for this population are compounded by developing dementia, which has been shown to contribute to high levels of oral disease. Other risk factors include various physical, respiratory, and oral impairments. Due to oral health issues, the intake of food is sometimes severely impacted.^1–3

The Oral Connection

Dental plaque is thought to be a major contributor in NHAP, which often occurs via aspiration. The heavy accumulation of unchecked plaque in older residents is a reservoir for pathogens, and residents with NHAP often have such a buildup. In particular, the build-up of Candida albicans in a resident’s oral cavity is thought to be one cause of fatal aspiration pneumonia.¹

To adequately address the problem many LTC residents would need to rely on staff for daily oral care to keep the plaque burden low. This could involve swabbing the oropharynx with povidone iodine after meals and implementing appropriate oral care tools to keep teeth and dentures clean. It would also require the hiring of dental hygienists to provide weekly oral healthcare.

The study showed that the most effective strategy is likely the provision of full-time dental hygienists, providing weekly care to residents onsite in LTC. Such professionals could also offer instruction and education for residents, staff, and caregivers.¹

The study provides evidence that such an arrangement could significantly reduce the risk of oral infection in LTC residents, which would reduce healthcare costs associated with treating respiratory illnesses such as pneumonia. The researchers advocate for the improvement of health policies to include regular, onsite professional oral healthcare for vulnerable or dependent LTC residents.

References

1. Marusiak MJ, Paulden M, Ohinmaa A. Professional health care prevents mouth-lung infection in long-term care homes: a systematic review. Can J Dent Hyg. 2023;57:180-190.
2. Stamm DR, Katta S, Stankewicz HA. Nursing home-acquired pneumonia.
3. Yoon MN , Ickert C , Slaughter SE , Lengyel C , Carrier N , Keller H.Oral health status of long-term care residents in Canada: results of a national cross-sectional study. Gerodontology. 2018;35:359-364.