Cleaning Teeth Prevents Pneumonia in Nursing Homes

NEW YORK (Reuters Health) - Regular cleanings of teeth and gums may help prevent pneumonia in nursing home residents, new research suggests.

The results are based on comparing pneumonia rates between residents of 11 nursing homes in Japan who received regular teeth cleanings and those who received no additional oral care.

The researchers, led by Takeyoshi Yoneyama of Tohoku University in Sendai, Japan, found that residents whose teeth were regularly cleaned had fewer cases of pneumonia and were less likely to die from the infection.

Speaking with Reuters Health, Dr. Kenneth Shay of the University of Michigan in Ann Arbor, who co-authored an editorial accompanying the study, explained that pneumonia is caused by germs that build up in the lungs and block the flow of oxygen to the body. If the mouth is not clean, there are more germs in the mouth and throat, increasing the chances of sparking an infection.

"If air and/or material brought into the lungs has lots of germs in it to begin with, it makes it easier for an infection to get started," he said.

However, Shay said that the oral care administered in this study was quite intense, and perhaps not something to which all nursing home residents would agree. As part of the study, 184 residents were given tooth brushings after every meal and some were swabbed with a bad-tasting antiseptic. In addition, they received professional cleanings once a week from a dentist or dental hygienist.

Some of the 182 residents not assigned to the oral care group brushed their own teeth, and those with dentures had them cleaned regularly, but they did not receive any additional assistance in cleaning their teeth or dentures, the report indicates.

After following the patients for 2 years, the investigators found that residents whose teeth were not given additional dental care were almost twice as likely to get pneumonia. In addition, these residents were twice as likely to die from the infection, relative to those whose teeth were cleaned regularly, according to the report in the latest issue of the Journal of the American Geriatrics Society.

One of the required daily nursing chores in US nursing homes is oral care, but previous studies have shown that this is rarely enforced or done effectively. While ensuring residents receive regular dental care will cost money, Shay noted, the price is significantly less than the costs associated with pneumonia. Although most patients may not like the antiseptic, he said facilities could hire a staff member exclusively charged with brushing residents' teeth.

"It is very compelling to have evidence that a common-sense, cheap, anyone-can-do-it intervention--that is supposed to be done anyway--could be saving multiple billions of dollars, if it were just done," he said.

The benefits of oral care go beyond simple economics, Shay added. "As important as the cost savings, though, should be the improved odor, taste perception, food enjoyment, and social interaction--altogether loosely referred to as quality of life--that occurs when the daily oral care is provided as it should be."

SOURCE: Journal of the American Geriatrics Society 2002;50:430-433.

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