Pneumonia remains the leading cause of death in nursing home residents. The accumulation of dental plaque and colonization of oral surfaces and dentures with respiratory pathogens serves as a reservoir for recurrent lower respiratory tract infections.

Reference: Ali A. El-Solh, Association Between Pneumonia and Oral Care in Nursing Home Residents

While resources may be limited in long-term-care facilities, incorporating oral care in daily routine practice helps to reduce systemic diseases and to promote overall quality of life in nursing home residents.

Reference: Ali A. El-Solh, Association Between Pneumonia and Oral Care in Nursing Home Residents

With skyrocketing health-care costs and the increasing incidence of aspiration pneumonia in the aging population, dental hygiene represents an effective cost-saving intervention.

Reference: Ali A. El-Solh, Association Between Pneumonia and Oral Care in Nursing Home Residents

The study concluded that good “hygiene practices may prevent the death of about one in 10 elderly residents of nursing homes from health care associated pneumonia.

Reference: A Journal of the American Dental Association

Improved oral hygiene, including professional oral care, significantly reduced the incidence of or progression of respiratory diseases among high-risk elders residing in nursing homes or being cared for in intensive care units (relative risk reduction, 34%-83%).

Reference: Azarpazhooh A, Leake JL. Systematic review of the association between respiratory diseases and oral health. J Periodontal. 2006;77(9): 1465-1482

A similar study examined dental plaque as the source for potential pathogenic organisms that may cause respiratory disease in nursing home residents 25. Of the 138 residents examined, 89 subjects presented with potential respiratory pathogens colonized from their dental plaque 26.

Reference:25. Sumi Y, Miura H, Michiwaki Y, Nagaosa S, Nagaya M (2007) Colonization of dental plaque by respiratory pathogens in dependent elderly. Arch Gerontol Geriatr 44:119-124
26. Leach SA (1967) Isolation in pure culture of human oral organism capable of producing neuraminidase. Nature 216:599-600

The aging of the United States (US) population has occurred steadily over the last century, and this trend is expected to continue in the coming decades. In 1995, 33 million people aged 65 and older comprised 13% of the population. By 2030, the percentage of people aged 65 and older will rise to 20% of the population 1. Currently, 4.1% of people in the US older than 65 reside in long-term-care facilities (LTCF’s), and 15% of people older than 85 are nursing home residents 2.

Twelve studies conducted in a variety of North American LTCF’s since 1978 indicate that the overall incidence of infections in these facilities range between 1.8 and 13.5 infections per 1,000 resident care days 3. Pneumonia remains the leading cause of death attributable to infection in patients aged 65 and older and accounts for 13-48% of infections in the nursing home setting, with mortality rates as high as 55% 4,5.

References

1. US Department of Health and Human Services. HHS News, August 31, 1995, pp 1-3
2. Strahan GW (1997) An overview of nursing homes and their current residents: data from the 1995 National Nursing Home Survey. Adv Data 280:1-12
3. Strausbaugh L (1999) Epidemiology and prevention of infections in residents of long-term care facilities. In: Mayhall CG (ed) Hospital epidemiology and infection control. Lippincott, Williams & Wilkins, New York, pp 1461-1482
4. Norman DC (1991) Pneumonia in the elderly: empiric antimicrobial therapy. Geriatrics 46:26-32
5. Mehr DR, Zweig SC, Kruse RL, Popejoy L, Horman D et al (1998) Mortality from lower respiratory infection in nursing home residents. A pilot prospective community-based study. J Fam Pract 47:298-304

Of the residents assessed, more than 71% expressed willingness to receive dental care 32.

Reference: Henry RG (1995) Functionally dependent veterans. Issues related to providing and improving their oral health care. Med Care 33:NS143-NS163

A recent study involving 143 residents of a nursing home investigated the association between the assignment of an oral hygiene aide staff member and mortality from pneumonia. When the data were adjusted… the odds of dying from pneumonia in the group that did not receive oral care was more than three times that of the group that did receive oral care (OR = 3.57, p = 0.03) 29

Reference:
29. Bassim CW, Gibson G, Ward T, Paphides BM, Denucci DJ (2008) Modification of the risk of mortality from pneumonia with oral hygiene care. J Am Geriatr Soc 56:1601-1607