Dental care helps to decrease pneumonia in older patients in nursing homes.

In Nursing Homes, an Epidemic of Poor Dental Hygiene - The New York Times
Image Source: Alabama Nursing Home Association

It should be noted that pneumonia is not only an illness frequent in older individuals, but it is also the most prevalent kind of illness that results in mortality from nosocomial infection among older individuals. The oropharynx is assumed to be inhabited by bacteria that spread to the lower respiratory system by the ingestion of oral germs, and the aspiration of oral material has been theorized as the means by which these bacteria reach the lower respiratory system. Patients in nursing homes, as is the case for those in assisted living facilities, tend to have inadequate oral hygiene practices and this, along with the lack of access to professional dental treatment, may result in poor oral health. Amenorrhea, adenomyosis, adenocarcinomas, adenomatous hyperplasia, and adenomatous polyps may all be symptoms of anaerobic bacteria that have infected the pelvic organs and are passed to others via the sexual route. Since tooth plaque would seem to be an apparent source of these bacteria, particularly in people with periodontal disease, this may be the likely source of these germs. Our understanding shows that, to our knowledge, whether improvements in oral hygiene might lessen the risk in any of the two settings has not been investigated. To further test this hypothesis, we will do a follow-up research in which we treat these individuals with dental care to lower the incidence of respiratory infections. There has already been a preliminary study that you may be interested in reading.

The current investigation focused on elderly people in Japan, who reside in 11 different long-term care facilities. In addition to providing long-term care, every nursing home contains between 50 to 100 beds and functions as a center for elderly patients who are physically handicapped or are suffering from mental degeneration. Their daily life activities are entirely dependent on caretakers, and in great part on their ability to assist them (ADLs). When it came to patient selection, the only factor that mattered was that symptoms and cognitive dysfunction must have been constant over the previous three months. During this three-month period, no patient had a sudden illness (e.g., severe infection, heart failure, or stroke requiring special treatment and intensive care). Patients in the study suffered from conditions including heart disease, hypertension, arrhythmia, a prior heart infection, diabetes, and stomach ulcers that were not being actively treated. There was variability in mental function, from minor cognitive impairments to dementia. Only a few residents in each nursing home could participate in the research because they were unable to comply. This research was financed by the Japan Welfare Ministry’s Funds for Comprehensive Research on Aging and Health, which was established in 1999 and remained in operation until 2000.

To yet, no patient has suffered a long-term (chronic) lung condition like chronic obstructive pulmonary disease (COPD) or pulmonary fibrosis. All the patients were able to feed themselves or required assistance in eating; no patient required feeding tubes. Each nursing home used the same floor and nursing staff, as well as being located on the same floor, to randomly choose patients for their study. A random numbers table was used to randomize the selection list, and the list was separately managed by the investigators. It was an unbroken tradition for thirty years that no dentist had been in command of the facility before the research. This experiment was performed in September 1996, with four hundred seventeen patients randomly allocated to an oral care group or a no oral care group. They were examined for two years to find out whether they benefited from the oral care provided. To meet the criteria for pneumonia diagnosis, a patient must have a new infiltrate detected on a chest radiograph, and one of the following characteristics: fever higher than 37.8 C, or the subjective sense of being short of breath. Two radiologists who were not associated with the investigations concluded that pneumonia was the correct diagnosis. Even though, 51 patients had died due to reasons other than pneumonia at the time of follow-up, their results were removed from the study. Before the study, the results of a physical examination and chest radiograph were done. When the patients had finished eating, the nurses or carers would use a toothbrush to clean the patients’ teeth for around 5 minutes after each meal. Dental care, including daily toothbrushing and excluding dentifrice, was applied as normal for healthy teeth and gums, and to brush the palatal and mandibular mucosa and tongue dorsum. Oral hygiene effectiveness would have been greatly reduced if the toothbrush was inefficient. Some patients have had to use applicators with a little quantity of povidone iodine (1%) with no rinsing required, while others used rinsing but still needed a minimal quantity of povidone iodine. Despite not requesting treatment from caregivers, numerous patients in the nonoral care group completed toothbrushing a single time each day or less often, but none of them had sought oral care. A hundred sixty-three patients were found to be wearing dentures. Every day, dentures were cleaned with a denture brush and cleaner. Weekly, they were washed with denture cleanser alone. To help keep their teeth healthy, the dental professionals or dental hygienists offered weekly professional treatment, including cleaning, management of plaque and calculus, once per week for the oral care group.

Pneumonia is referred to as “the old man’s buddy” since pneumonia is more prevalent in elderly persons and contributes to significant mortality. 12 When it comes to institutionalized patients, about 80% perished from complications of pneumonia; however, for patients in a clinical setting, such as a hospital, the mortality from pneumonia was approximately half of what it was for those who were not institutionalized. According to the results of a mortality study after pneumonia, providing dental care was shown to be far more beneficial in reducing death than providing medical therapy for pneumonia. Not only may oral health influence such functions as eating, swallowing, speaking, facial aesthetics, and social interaction, but it may also impact a person’s overall quality of life. 13,000 feet of real-time data MMS When patients received dental care, their consumption of the 24th month was substantially different from that in patients who did not get dental care. While this was the case, however, we did not see any overall improvement in ADL and MMSE scores in patients that received dental care. Regardless of the presence of pneumonia, we gave the MMSE to individuals who were alive for at least two years. As a result, people who have pneumonia may see decreases in ADL and MMSE.


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