1887

Abstract

Bacterial pneumonia is a common cause of morbidity and mortality in elderly individuals. While the incidence of edentulism is falling, approximately 19 % of the UK population wear a full or partial removable denture. Despite advances in denture biomaterials, the majority of dentures are fabricated using polymethyl-methacrylate. Growing evidence suggests that colonization of the oral cavity by putative respiratory pathogens predisposes individuals to respiratory infection, by translocation of these microorganisms along the respiratory tract.

We hypothesized that denture surfaces provide a susceptible colonization site for putative respiratory pathogens, and thus could increase pneumonia risk in susceptible individuals.

This study aimed to characterize the bacterial community composition of denture-wearers in respiratory health compared with individuals with a confirmed diagnosis of pneumonia.

This was an analytical cross-sectional study, comparing frail elderly individuals without respiratory infection (=35) to hospitalized patients with pneumonia (=26). The primary outcome was the relative abundance of putative respiratory pathogens identified by 16S rRNA metataxonomic sequencing, with quantitative PCR used to identified .

There was a statistically significant increase in the overall relative abundance of putative respiratory pathogens (<0.0001), with a greater than 20-fold increase in the bioburden of these microorganisms. In keeping with these findings, there were significant shifts in bacterial community diversity (Chao index, =0.0003) and richness (Inverse Simpson index <0.0001) in the denture-associated microbiota of pneumonia patients compared with control subjects.

Within the limitations of this study, our evidence supports the role of denture acrylic biomaterials as a potential colonization site for putative respiratory pathogens, which may lead to an increased risk of pneumonia in susceptible individuals. These findings support prior observational studies which have found denture-wearers to be at increased risk of respiratory infection. Further research is needed to confirm the sequence of colonization and translocation to examine potential causal relationships.

Funding
This study was supported by the:
  • British Society for Oral and Dental Research (Award Oral and Dental Research Trust)
    • Principle Award Recipient: JoshuaA Twigg
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. This article was made open access via a Publish and Read agreement between the Microbiology Society and the corresponding author’s institution.
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.001702
2023-06-21
2024-06-15
Loading full text...

Full text loading...

/deliver/fulltext/jmm/72/6/jmm001702.html?itemId=/content/journal/jmm/10.1099/jmm.0.001702&mimeType=html&fmt=ahah

References

  1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet 2012; 380:2224–2260 [View Article]
    [Google Scholar]
  2. Welte T, Torres A, Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax 2012; 67:71–79 [View Article] [PubMed]
    [Google Scholar]
  3. Myles PR, Hubbard RB, Gibson JE, Pogson Z, Smith CJP et al. Pneumonia mortality in a UK general practice population cohort. Eur J Public Health 2009; 19:521–526 [View Article] [PubMed]
    [Google Scholar]
  4. McLuckie A. Respiratory Disease and Its Management London: Springer Science & Business Media; 2009 [View Article]
    [Google Scholar]
  5. Cillóniz C, Civljak R, Nicolini A, Torres A. Polymicrobial community-acquired pneumonia: an emerging entity. Respirology 2016; 21:65–75 [View Article]
    [Google Scholar]
  6. Torres A, Blasi F, Peetermans WE, Viegi G, Welte T. The aetiology and antibiotic management of community-acquired pneumonia in adults in Europe: a literature review. Eur J Clin Microbiol Infect Dis 2014; 33:1065–1079 [View Article]
    [Google Scholar]
  7. Torres A, Lee N, Cilloniz C, Vila J, Van der Eerden M. Laboratory diagnosis of pneumonia in the molecular age. Eur Respir J 2016; 48:1764–1778 [View Article]
    [Google Scholar]
  8. Azarpazhooh A, Leake JL. Systematic review of the association between respiratory diseases and oral health. J Periodontol 2006; 77:1465–1482 [View Article] [PubMed]
    [Google Scholar]
  9. O’Grady NP, Murray PR, Ames N. Preventing ventilator-associated pneumonia: does the evidence support the practice?. JAMA 2012; 307:2534–2539 [View Article] [PubMed]
    [Google Scholar]
  10. Paju S, Scannapieco FA. Oral biofilms, periodontitis, and pulmonary infections. Oral Dis 2007; 13:508–512
    [Google Scholar]
  11. Awano S, Ansai T, Takata Y, Soh I, Akifusa S et al. Oral health and mortality risk from pneumonia in the elderly. J Dent Res 2008; 87:334–339 [View Article] [PubMed]
    [Google Scholar]
  12. Sands KM, Twigg JA, Lewis MAO, Wise MP, Marchesi JR et al. Microbial profiling of dental plaque from mechanically ventilated patients. J Med Microbiol 2016; 65:147–159 [View Article] [PubMed]
    [Google Scholar]
  13. Sands KM, Wilson MJ, Lewis MAO, Wise MP, Palmer N et al. Respiratory pathogen colonization of dental plaque, the lower airways, and endotracheal tube biofilms during mechanical ventilation. J Crit Care 2017; 37:30–37 [View Article] [PubMed]
    [Google Scholar]
  14. Hua F, Xie H, Zhang Q, Li C, Worthington HV et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev 2020; 12:CD008367 [View Article] [PubMed]
    [Google Scholar]
  15. 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] [PubMed]
    [Google Scholar]
  16. 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] [PubMed]
    [Google Scholar]
  17. O’Donnell LE, Smith K, Williams C, Nile CJ, Lappin DF et al. Dentures are a reservoir for respiratory pathogens. J Prosthodont 2016; 25:99–104 [View Article] [PubMed]
    [Google Scholar]
  18. Yoneyama T, Yoshida M, Ohrui T, Mukaiyama H, Okamoto H et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 2002; 50:430–433 [View Article] [PubMed]
    [Google Scholar]
  19. Scannapieco FA, Binkley CJ. Modest reduction in risk for ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation following topical oral chlorhexidine. J Evid Based Dent Pract 2012; 12:15–17 [View Article] [PubMed]
    [Google Scholar]
  20. Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 2009; 64 Suppl 3:iii1–55 [View Article] [PubMed]
    [Google Scholar]
  21. Newton AV. Denture sore mouth: a possible aetiology. Br Dent J 1962; 112:357–360
    [Google Scholar]
  22. Klein H, Palmer CE, Knutson JW. Studies on dental caries. Public health rep 1938; 53:751–765 [View Article]
    [Google Scholar]
  23. The European Committee on Antimicrobial Susceptibility Testing Disc diffusion manual v9.0. EUCAST; 2021 http://www.eucast.org/ast_of_bacteria/disk_diffusion_methodology/ accessed 14 February 2021
  24. Gadsby NJ, McHugh MP, Russell CD, Mark H, Conway Morris A et al. Development of two real-time multiplex PCR assays for the detection and quantification of eight key bacterial pathogens in lower respiratory tract infections. Clin Microbiol Infect 2015; 21:788 [View Article] [PubMed]
    [Google Scholar]
  25. R Development Core Team. R: A language and environment for statistical computing. c1999-2013. R Foundation for Stastical Computing. n.d http://lib.stat.cmu.edu/R/CRAN/doc/manuals/r-devel/fullrefman.pdf accessed 14 February 2021
  26. Schloss PD, Westcott SL, Ryabin T, Hall JR, Hartmann M et al. Introducing mothur: open-source, platform-independent, community-supported software for describing and comparing microbial communities. Appl Environ Microbiol 2009; 75:7537–7541 [View Article] [PubMed]
    [Google Scholar]
  27. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40:373–383 [View Article] [PubMed]
    [Google Scholar]
  28. Benjamini Y, Krieger A, Yekutieli D. Two staged linear step up FDR controlling procedure. Tel Aviv University, and Department of Statistics, Wharton School, University of Pennsylvania; 2001
  29. Segata N, Izard J, Waldron L, Gevers D, Miropolsky L et al. Metagenomic biomarker discovery and explanation. Genome Biol 2011; 12:R60 [View Article] [PubMed]
    [Google Scholar]
  30. Dickson RP, Huffnagle GB, Goldman WE. The lung microbiome: new principles for respiratory bacteriology in health and disease. PLoS Pathog 2015; 11:e1004923 [View Article] [PubMed]
    [Google Scholar]
  31. Holter JC, Müller F, Bjørang O, Samdal HH, Marthinsen JB et al. Etiology of community-acquired pneumonia and diagnostic yields of microbiological methods: a 3-year prospective study in Norway. BMC Infect Dis 2015; 15:64 [View Article] [PubMed]
    [Google Scholar]
  32. Zubrod CG, Schneiderman M, Frei E, Brindley C, Lennard Gold G et al. Appraisal of methods for the study of chemotherapy of cancer in man: Comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. J Chronic Dis 1960; 11:7–33 [View Article]
    [Google Scholar]
  33. Bellera CA, Rainfray M, Mathoulin-Pélissier S, Mertens C, Delva F et al. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol 2012; 23:2166–2172 [View Article] [PubMed]
    [Google Scholar]
  34. Hill AB. The environment and disease: association or causation. Proc R Soc Med 1965; 58:295–300 [PubMed]
    [Google Scholar]
  35. Aggarwal S, Stewart PS, Hozalski RM. Biofilm cohesive strength as a basis for biofilm recalcitrance: are bacterial biofilms overdesigned?. Microbiol Spectr 2015; 8:29–32 [View Article] [PubMed]
    [Google Scholar]
  36. Bouza E, Cercenado E. Klebsiella and enterobacter: antibiotic resistance and treatment implications. Semin Respir Infect 2002; 17:215–230 [View Article] [PubMed]
    [Google Scholar]
  37. Sommer MOA, Dantas G. Antibiotics and the resistant microbiome. Curr Opin Microbiol 2011; 14:556–563 [View Article] [PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.001702
Loading
/content/journal/jmm/10.1099/jmm.0.001702
Loading

Data & Media loading...

Supplements

Supplementary material 1

PDF
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error