SENDAI, JAPAN—Pneumonia is one of the most common causes of death among elderly nursing home residents. Poor oral health is often a problem in this group, and dental plaque contributes to the presence of pneumonia-causing bacteria, which can enter the lower respiratory tract through silent aspiration. Recent research has shown that providing dental care to nursing home residents can reduce both the incidence of pneumonia and the costs associated with its treatment.

In a two-year randomized study by Takeyoshi Yoneyama, DDS, PhD, and colleagues,[1] 366 residents from 11 nursing homes were randomly assigned either to an oral care group or to a no–oral care group. In the oral care group, a nurse or caregiver cleaned patients’ teeth after each meal. If necessary, the oropharynx was scrubbed with an applicator using povidone-iodine. In addition, dentists and/or dental hygienists administered professional care, such as plaque removal and tartar control, once weekly in the oral care group. In the no–oral care group, patients performed tooth brushing themselves.

LESS ILLNESS—WITH OR WITHOUT TEETH

New cases of pneumonia were diagnosed in 21 of 184 patients in the oral care group compared with 34 of 182 patients in the no–oral care group. As a result of pneumonia, 14 patients in the oral care group and 30 in the no–oral care group died. The relative risk of death due to pneumonia in patients in the no–oral care group (compared with those in the oral care group) was 2.40.

The study results debunk the notion that people without their own teeth have fewer dental-related systemic diseases than do those who retain their teeth. Fever, pneumonia, and death from pneumonia occurred at similar rates regardless of the presence of original teeth. Additionally, patients without their own teeth benefited from oral care to the same degree as did patients with teeth.

Margaret Terpenning, MD, author of an editorial commentary on the study,[2] told PULMONARY REVIEWS that it isn’t surprising for people without their own teeth to derive benefits from oral care. “This is because both groups, those with teeth and those without teeth or with dentures, have a problem with oral cleanliness.” People without teeth “can aspirate dangerous organisms from the mouth … [and both groups] often have food particles contributing to the hygiene problem in the mouth as well,” she said.

BEYOND BETTER HEALTH

The annual cost of treating pneumonia acquired in nursing homes in the United States exceeds $8 billion, observed Dr. Terpenning, who is an Associate Professor of Internal and Geriatric Medicine at the University of Michigan and the Ann Arbor VA Hospital. Oral risk factors for pneumonia included the number of decayed teeth, presence of decay-causing organisms, and periodontal disease.[2]

Long-term care facilities do not make oral health a high priority, noted Dr. Terpenning, and caregivers have little or no training in performing oral care procedures. The use of specific aides trained and assigned to provide oral care has been dismissed as too costly. The present study, however, illustrates the effectiveness of such a program.

Dr. Terpenning determined that if every nursing home in the United States (there are about 19,000) hired a nurse’s aide simply to provide oral care at a yearly salary of $25,000 with benefits, the total annual cost would be less than $500 million. If the rate of pneumonia decreased by only 10% because of this intervention, the annual savings would exceed $800 million.[2] The 30% decrease predicted in the study by Dr. Yoneyama and colleagues points to an even greater financial benefit.

Further research on oral care as an economical measure against pneumonia will be needed before widespread procedural changes are put into practice. “Researchers need to be given the chance to demonstrate this cost saving and … the increase in quality of life that comes from better oral hygiene,” Dr. Terpenning said.

—Gale Jurasek

References
1. Yoneyama T, Yoshida M, Ohrui T, et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc. 2002;50:430-433.
2. Terpenning M, Shay K. Oral health is cost-effective to maintain but costly to ignore. J Am Geriatr Soc. 2002;50:584-585.

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