1887

Abstract

To investigate the effect of daily toothbrushing with 0.2 % chlorhexidine digluconate (CHX) on the colonization of dental plaque by pathogens associated with pneumonia amongst non-ventilated adults with a neuro-disability.

Forty-nine patients living in long-term care were recruited. Daily toothbrushing with 0.2 % CHX gel was conducted for 48 weeks. Plaque accumulation was assessed and microbiological sampling was undertaken every 6 weeks.

At any one time point at least 65 % (=32) of subjects were found to harbour respiratory pathogens. Although there were significant changes in the proportion of individuals colonized over time with Gram-negative bacilli and the changes were not sustained. By week 48 there was no significant difference from the levels that had been recorded at baseline.

Bacteria known to be causal in pneumonia are present and colonize the dental plaque of non-ventilated adults with a neuro-disability. Daily toothbrushing with 0.2 % CHX gel did not produce a sustained reduction in intra-oral respiratory pathogen counts after 48 weeks.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial License.
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2019-12-01
2024-03-28
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References

  1. Son YG, Shin J, Ryu HG. Pneumonitis and pneumonia after aspiration. J Dent Anesth Pain Med 2017; 17:1–12 [View Article]
    [Google Scholar]
  2. Jia G, Zhi A, Lai PFH, Wang G, Xia Y et al. The oral microbiota - a mechanistic role for systemic diseases. Br Dent J 2018; 224:447–455 [View Article]
    [Google Scholar]
  3. Mojon P. Oral health and respiratory infection. J Can Dent Assoc 2002; 68:340–345
    [Google Scholar]
  4. Patterson CM, Loebinger MR. Community acquired pneumonia: assessment and treatment. Clin Med 2012; 12:283–286 [View Article]
    [Google Scholar]
  5. van der Maarel-Wierink CD, Vanobbergen JNO, Bronkhorst EM, Schols JMGA, de Baat C. Meta-analysis of dysphagia and aspiration pneumonia in frail elders. J Dent Res 2011; 90:1398–1404 [View Article]
    [Google Scholar]
  6. Langmore SE, Terpenning MS, Schork A, Chen Y, Murray JT et al. Predictors of aspiration pneumonia: how important is dysphagia?. Dysphagia 1998; 13:69–81 [View Article]
    [Google Scholar]
  7. Scannapieco FA. Role of oral bacteria in respiratory infection. J Periodontol 1999; 70:793–802 [View Article]
    [Google Scholar]
  8. Department of Health Delivering Better Oral Health: an Evidence-Based Toolkit for Prevention, 3rd Edition. London, UK: Department of Health; 2017
    [Google Scholar]
  9. Lewis D, Fiske J, Dougall A. Access to special care dentistry, part 7. Special care dentistry services: seamless care for people in their middle years--part 1. Br Dent J 2008; 205:305317 [View Article]
    [Google Scholar]
  10. Yoon MN, Steele CM. Health care professionals' perspectives on oral care for long-term care residents: nursing staff, speech-language pathologists and dental hygienists. Gerodontology 2012; 29:e525–e535 [View Article]
    [Google Scholar]
  11. Sumi Y, Miura H, Michiwaki Y, Nagaosa S, Nagaya M. Colonization of dental plaque by respiratory pathogens in dependent elderly. Arch Gerontol Geriatr 2007; 44:119–124 [View Article]
    [Google Scholar]
  12. Scannapieco FA, Stewart EM, Mylotte JM. Colonization of dental plaque by respiratory pathogens in medical intensive care patients. Crit Care Med 1992; 20:740–745 [View Article]
    [Google Scholar]
  13. Manger D, Walshaw M, Fitzgerald R, Doughty J, Wanyonyi KL et al. Evidence summary: the relationship between oral health and pulmonary disease. Br Dent J 2017; 222:527533 [View Article]
    [Google Scholar]
  14. Hua F, Xie H, Worthington HV, Furness S, Zhang Q et al. Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia. The Cochrane Library 2016
    [Google Scholar]
  15. Department of Health Mental Capacity Act 2005: Code of Practice London, UK: Department of Health; 2007
    [Google Scholar]
  16. Scannapieco FA. Role of oral bacteria in respiratory infection. J Periodontol 1999; 70:793–802 [View Article]
    [Google Scholar]
  17. Torres A, Peetermans WE, Viegi G, Blasi F. Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax 2013; 68:1057–1065 [View Article]
    [Google Scholar]
  18. Lam OLT, McMillan AS, Samaranayake LP, Li LSW, McGrath C. Effect of oral hygiene interventions on opportunistic pathogens in patients after stroke. Am J Infect Control 2013; 41:149–154 [View Article]
    [Google Scholar]
  19. Ab Malik N, Abdul Razak F, Mohamad Yatim Sa'ari, Lam OLT, Jin L et al. Oral health interventions using Chlorhexidine-Effects on the prevalence of oral opportunistic pathogens in stroke survivors: a randomized clinical trial. J Evid Based Dent Pract 2018; 18:99–109 [View Article]
    [Google Scholar]
  20. Centres for Disease Control and Prevention (CDC) Pseudomonas aeruginosa in healthcare settings (Internet). USA: centres for disease control and prevention (CDC); 2013 (updated 2018 March 9; cited 2018 may 15). https://www.cdc.gov/hai/organisms/pseudomonas.html
  21. Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R et al. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004; 53:1–36
    [Google Scholar]
  22. American thoracic Society and the infectious diseases Society of America. guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171:388–416
    [Google Scholar]
  23. Mathur S, Mathur T, Srivastava R, Khatri R. Chlorhexidine: the gold standard in chemical plaque control. NJPPP 2011; 1:
    [Google Scholar]
  24. Jones CG. Chlorhexidine: is it still the gold standard?. Periodontol 2000 1997; 15:55–62 [View Article]
    [Google Scholar]
  25. Ćabov T, Macan D, Husedžinović I, Bošnjak D et al. The impact of oral health and 0.2% chlorhexidine oral gel on the prevalence of nosocomial infections in surgical intensive-care patients: a randomized placebo-controlled study Einfluss von Mundgesundheit und von 0, 2% Chlorhexidin-Gel auf die entwicklung von nosokomialen infektionen bei patienten auf einer chirurgischen intensivstation. Wien Klin Wochenschr 2010; 122:397–404
    [Google Scholar]
  26. Fourrier F, Cau-Pottier E, Boutigny H, Roussel-Delvallez M, Jourdain M et al. Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients. Intensive Care Med 2000; 26:1239–1247 [View Article]
    [Google Scholar]
  27. Grap MJ, Munro CL, Elswick RK, Sessler CN, Ward KR. Duration of action of a single, early oral application of chlorhexidine on oral microbial flora in mechanically ventilated patients: a pilot study. Heart Lung 2004; 33:83–91 [View Article]
    [Google Scholar]
  28. Tuon FF, Gavrilko O, Almeida Sde, Sumi ER, Alberto T et al. Prospective, randomised, controlled study evaluating early modification of oral microbiota following admission to the intensive care unit and oral hygiene with chlorhexidine. J Glob Antimicrob Resist 2017; 8:159–163 [View Article]
    [Google Scholar]
  29. Zand F, Zahed L, Mansouri P, Dehghanrad F, Bahrani M et al. The effects of oral rinse with 0.2% and 2% chlorhexidine on oropharyngeal colonization and ventilator associated pneumonia in adults' intensive care units. Journal of critical care 2017; 40:318–322
    [Google Scholar]
  30. Russell SL, Boylan RJ, Kaslick RS, Scannapieco FA, Katz RV. Respiratory pathogen colonization of the dental plaque of institutionalized elders. Spec Care Dentist 1999; 19:128–134 [View Article]
    [Google Scholar]
  31. Scannapieco FA. Pneumonia in nonambulatory patients: the role of oral bacteria and oral hygiene. J Am Dent Assoc 2006; 137:S21–S25
    [Google Scholar]
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