Oral Care: Does Oral Care Have Preventive Roles in Aspiration Pneumonia?

2020 ◽  
pp. 175-186
Author(s):  
Kazuharu Nakagawa ◽  
Koji Hara ◽  
Haruka Tohara
Keyword(s):  
Aspiration Pneumonia ◽  
Oral Care

scholarly journals Oral care after stroke: Where are we now?

2018 ◽  
Vol 3 (4) ◽  
pp. 347-354 ◽  
Author(s):  
Mary Lyons ◽  
Craig Smith ◽  
Elizabeth Boaden ◽  
Marian C Brady ◽  
Paul Brocklehurst ◽  
...  
Keyword(s):  
Aspiration Pneumonia ◽  
Best Practice ◽  
Clinical Care ◽  
Oral Care ◽  
Research Priorities ◽  
Stroke Care ◽  
Weak Evidence ◽  
Perspective Drawing ◽  
Increased Risk ◽  
Risk Of Aspiration

Purpose There appears to be an association between poor oral hygiene and increased risk of aspiration pneumonia – a leading cause of mortality post-stroke. We aim to synthesise what is known about oral care after stroke, identify knowledge gaps and outline priorities for research that will provide evidence to inform best practice. Methods A narrative review from a multidisciplinary perspective, drawing on evidence from systematic reviews, literature, expert and lay opinion to scrutinise current practice in oral care after a stroke and seek consensus on research priorities. Findings: Oral care tends to be of poor quality and delegated to the least qualified members of the caring team. Nursing staff often work in a pressured environment where other aspects of clinical care take priority. Guidelines that exist are based on weak evidence and lack detail about how best to provide oral care. Discussion Oral health after a stroke is important from a social as well as physical health perspective, yet tends to be neglected. Multidisciplinary research is needed to improve understanding of the complexities associated with delivering good oral care for stroke patients. Also to provide the evidence for practice that will improve wellbeing and may reduce risk of aspiration pneumonia and other serious sequelae. Conclusion Although there is evidence of an association, there is only weak evidence about whether improving oral care reduces risk of pneumonia or mortality after a stroke. Clinically relevant, feasible, cost-effective, evidence-based oral care interventions to improve patient outcomes in stroke care are urgently needed.

scholarly journals Poor oral hygiene, oral microorganisms and aspiration pneumonia risk in older people in residential aged care: a systematic review

2020 ◽  
Author(s):  
Sangeeta Khadka ◽  
Shahrukh Khan ◽  
Anna King ◽  
Lynette R Goldberg ◽  
Leonard Crocombe ◽  
...  
Keyword(s):  
Oral Health ◽  
Older People ◽  
Aspiration Pneumonia ◽  
Oral Hygiene ◽  
Oral Care ◽  
Aged Care ◽  
Oral Microbiome ◽  
Residential Aged Care ◽  
Pathogenic Microorganisms ◽  
Oral Microorganisms

Abstract Background aspiration pneumonia increases hospitalisation and mortality of older people in residential aged care. Objectives determine potentially pathogenic microorganisms in oral specimens of older people with aspiration pneumonia and the effect of professional oral care in reducing aspiration pneumonia risk. Data Sources PUBMED/MEDLINE, CINAHL, EMBASE, COCHRANE, PROQUEST, Google Scholar, Web of Science. Study Eligibility Criteria published between January 2001 and December 2019 addressing oral microorganisms, aspiration pneumonia, oral health and treatment. Participants people 60 years and older in residential aged care. Study Appraisal and Synthesis Methods the Newcastle–Ottawa Scale and the Standard Protocol Items: Recommendations for Intervention Trials checklist. Results twelve studies (four cross-sectional, five cohort and three intervention) reported colonisation of the oral cavity of older people by microorganisms commonly associated with respiratory infections. Aspiration pneumonia occurred less in people who received professional oral care compared with no such care. Isolation of Candida albicans, Staphylococcus aureus, methicillin-resistant S. aureus and Pseudomonas aeruginosa was related to mortality due to aspiration pneumonia. An interesting finding was isolation of Escherichia coli, a gut bacterium. Limitations more information may be present in publications about other co-morbidities that did not meet inclusion criteria. A high degree of heterogeneity prevented a meta-analysis. Issues included sampling size, no power and effect size calculations; different oral health assessments; how oral specimens were analysed and how aspiration pneumonia was diagnosed. Conclusions and Implications of Key Findings pathogenic microorganisms colonising the oral microbiome are associated with aspiration pneumonia in older people in residential care; professional oral hygiene care is useful in reducing aspiration pneumonia risk.

scholarly journals Implementing oral care to reduce aspiration pneumonia amongst patients with dysphagia in a South African setting

2016 ◽  
Vol 63 (1) ◽  
Author(s):  
Jaishika Seedat ◽  
Claire Penn
Keyword(s):  
South Africa ◽  
Aspiration Pneumonia ◽  
Oral Care ◽  
Oropharyngeal Dysphagia ◽  
Free Water ◽  
Government Hospital ◽  
Thickened Liquids ◽  
Care Protocol ◽  
Water Provision ◽  
Patient Prognosis

Oral care is a crucial routine for patients with dysphagia that, when completed routinely, can prevent the development of aspiration pneumonia. There is no standardised protocol for oral care within government hospitals in South Africa. This study aimed to investigate the outcome of an oral care protocol. Participants were patients with oropharyngeal dysphagia, with either stroke or traumatic brain injury as the underlying medical pathology, and nurses. All participants were recruited from one tertiary level government hospital in Gauteng, South Africa. 139 nurses participated in the study and received training on the oral care protocol. There were two groups of participants with oropharyngeal dysphagia. Group one (study group, n = 23) was recruited by consecutive sampling, received regular oral care and were not restricted from drinking water; however, all other liquids were restricted. Group two (comparison group, n = 23) was recruited via a retrospective record review, received inconsistent oral care and were placed on thickened liquids or liquid restricted diets. Results showed that a regimen of regular oral care and free water provision when combined with dysphagia intervention did prevent aspiration pneumonia in patients with oropharyngeal dysphagia. The article highlights two key findings: that regular and routine oral care is manageable within an acute government hospital context and a strict routine of oral care can reduce aspiration pneumonia in patients with oropharyngeal dysphagia. An implication from these findings is confirmation that teamwork in acute care settings in developing contexts must be prioritised to improve dysphagia management and patient prognosis.

scholarly journals Clinical Significance of Oral Care and Oral Management on the Treatment and Prevention of Aspiration Pneumonia in the Elderly: Evidences and Pitfalls

2020 ◽  
pp. 1-5
Author(s):  
Shinji Teramoto ◽  
Shinji Teramoto
Keyword(s):  
Clinical Significance ◽  
Aspiration Pneumonia ◽  
Oral Care ◽  
The Elderly ◽  
Oral Bacteria ◽  
Healthcare Management ◽  
Elderly Persons ◽  
Swallowing Function ◽  
Treatment And Prevention ◽  
Swallowing Rehabilitation

Oral care and oral management are important for preventing aspiration pneumonia (ASP). The main pathology of ASP is microaspiration of oropharyngeal contents during night, swallowing rehabilitation must be necessary for the ASP treatment. However, swallowing rehabilitation cannot totally restore the normal swallowing function. Oral healthcare management should be initiated and continued in parallel with antibiotic treatment of ASP. Oral care helps to prevent aspiration pneumonia by reducing oral bacteria, while oral management helps by improving masticatory and rehabilitating functions. The efficacy of oral care for reducing the incidence of pneumonia has been clearly observed in untreated frail elderly patients, but not in well-cared elderly persons. It has been established that oral care is cyclically significant for the prevention of ASP in the elderly. However, oral problems are not the primary cause of ASP in the elderly. Although there is an amount of evidences of oral care for ASP prevention, there are some controversies of the clinical significance of oral care for ASP treatment.

scholarly journals Myofunctional Device Use in Oral Care and Swallowing: Protocol for a Pilot Study in an Aged Care Population

2021 ◽  
Author(s):  
Hollie-Ann Lee Shortland ◽  
Sally Hewat ◽  
Gwendalyn Webb ◽  
Anne E. Vertigan
Keyword(s):  
Oral Health ◽  
Pilot Study ◽  
Aspiration Pneumonia ◽  
Oral Hygiene ◽  
Systemic Disease ◽  
Oral Care ◽  
Chronically Ill ◽  
Aged Care ◽  
Care Staff ◽  
Secondary Outcome

Abstract BackgroundPoor oral health is a known predictor of aspiration pneumonia in vulnerable populations such as the elderly and chronically ill and has been linked to systemic disease, morbidity, and mortality. Reduced oral health not only places individuals at a greater risk of aspiration pneumonia but may result in pain or poorer dentition which can impact on mastication and swallowing. Consequences of this may include reduced oral intake, malnutrition, poorer health outcomes and reduced quality of life. Few evidence-based protocols exist to manage oral care in aged care populations, and maintenance of good oral hygiene is difficult for nursing and care staff to facilitate. However, myofunctional devices reportedly improve oral hygiene, oral behaviours, and swallowing, along with breathing and speech. The primary aims of this study are to assess the feasibility and acceptability of a using a myofunctional device to improve oral care and swallowing function in an aged care population. Methods/DesignThis project is a pilot study that involves a five-week intervention for oral hygiene and dysphagia for residents >65 years old in an aged care setting. Feasibility will be measured by number of consenting participants, trial completion rates, and treatment adherence. Acceptability will be measured through verbal surveys of aged care residents and a questionnaire of care staff assisting with the intervention. Secondary outcome measures will record changes in oral hygiene and dysphagia pre and post intervention. DiscussionThe results of this trial will provide important information regarding the acceptability and feasibility of utilising a myofunctional device to improve oral care and dysphagia in elderly patients in an aged care facility. This knowledge will further guide and inform design of a larger trial or future research. Trial registrationThis trial was registered 8/10/2021 with the Australian New Zealand Clinical Trials Registry and allocated the ACTRN: ACTRN12621001359820. Web address for trial: https://www.anzctr.org.au/ACTRN12621001359820.aspx

scholarly journals Efficacy of a New Post-Mouthwash Intervention (Wiping Plus Oral Nutritional Supplements) for Preventing Aspiration Pneumonia in Elderly People: A Multicenter, Randomized, Comparative Trial

2017 ◽  
Vol 71 (3-4) ◽  
pp. 253-260 ◽  
Author(s):  
Takashi Higashiguchi ◽  
Hiroshi  Ohara ◽  
Yayoi Kamakura ◽  
Takeshi Kikutani ◽  
Masafumi Kuzuya ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Aspiration Pneumonia ◽  
Complete Blood Count ◽  
Oral Care ◽  
Intervention Group ◽  
Comparative Trial ◽  
Nutritional Supplements ◽  
The Elderly ◽  
Control Group ◽  
Oral Nutritional Supplements

Background/Aims: Aspiration pneumonia is a common cause of death among the elderly (≥90-year-old) in nursing homes. Studies suggest that its incidence could be reduced by oral care interventions. We aimed to evaluate the efficacy of a new oral care intervention: wiping plus oral nutritional supplements (ONS). Methods: This prospective observational study was conducted in 252 patients (age 88.0 ± 6.5 years) in 75 nursing homes, rehabilitation hospitals, and other care facilities. Patients were randomly divided into an intervention group (n = 74) and a control group (n = 107), whose members received conventional oral care. Body mass index, activities of daily living (Barthel index), and complete blood count and biochemistry parameters were measured at 2, 4, 6, and 8 months. Results: The cumulative incidence of pneumonia at 8 months tended to be lower in the intervention than in the control group (7.8 vs. 17.7%, p = 0.056) and was significantly lower for men in the intervention group (p = 0.046). Conclusions: Our new intervention “wiping plus providing ONS” method appears to help prevent aspiration pneumonia, thereby reducing mortality risk. In this study, we disseminate information on how this method is used in Japan.

Oral Care Across Ages: A Review

2012 ◽  
Vol 21 (1) ◽  
pp. 3-8
Author(s):  
John R. Ashford
Keyword(s):  
Immune System ◽  
Dental Caries ◽  
Aspiration Pneumonia ◽  
Oral Care ◽  
Systemic Diseases ◽  
Oral Flora ◽  
Form Complex ◽  
Care Practices

Mouth cleaning is performed to prevent diseases such as dental caries, gingivitis, and periodontitis. Bacteria, present since birth, form complex biofilms that attach to oral surfaces. These florae—controlled with saliva, brushing, and the immune system—may contribute to systemic diseases, including aspiration pneumonia. This review examines oral properties, biofilms, potential disease associated with the oral flora, and oral care practices.

scholarly journals Reducing Aspiration Pneumonia Risk for Older People: Effect of Evidence-Based Oral Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 365-365
Author(s):  
Lynette Goldberg ◽  
Leonard Crocombe ◽  
Silvana Bettiol ◽  
Anna King ◽  
Sangeeta Khadka
Keyword(s):  
Older People ◽  
Aspiration Pneumonia ◽  
Lactobacillus Reuteri ◽  
Bacterial Species ◽  
Oral Care ◽  
Evidence Based ◽  
Regular Care ◽  
Bacteria And Fungi ◽  
Risk Of Aspiration ◽  
Evidence Based Care

Abstract Poor oral health increases the risk of aspiration pneumonia for older people. This is due primarily to six pathogens found in the mouth: five bacteria and one fungus. With a cohort of older people who were dependent on others for their oral care, we analyzed the load and type of bacteria and fungi from swabs of cheek, gum, and tongue mucosa. There were no significant differences between the three sites for load of bacteria (H (2) = .89; p = .64); there were significant differences between the sites for type of bacteria (F (2,78) = 11.97; p <.001) with the tongue showing the greatest diversity. There were no significant differences between the three sites for load (H (2) = 2.94; p = .23) or type (F (2,77) = .46; p = .63) of fungi. We then investigated the effect of regular compared to evidence-based oral care over a six-week period, and whether evidence-based oral care could significantly reduce the absolute count of the six oral pathogens specifically related to aspiration pneumonia. Participants self-selected into Regular Care (n = 10) and Evidence-based Care (n = 17) Groups. Evidence-based oral care resulted in significant decreases (p = .02 to p < .001) in the load of four potentially pathogenic bacterial species, including E. coli, gut-based bacteria, and in an increased load of Lactobacillus reuteri, a host-protective normal flora in the mouth, compared to baseline. There were no significant differences between groups for the abundance and type of fungi.

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