Public Health Implications of Chronic Periodontal Infections in Adults
Periodontal Diseases and Respiratory Infections
Frank Scannapeico,
DMD, PhD, Chair, Department of Oral Biology, School of Dental Medicine, State University of New York, Buffalo, New York
Several studies have suggested an association among dental plaque, poor
oral health, and respiratory disease. Many case studies have described
bacteria normally found in the oral cavity to be associated with lung
infections. In addition, oral health status may contribute to nosocomial pneumonia
and chronic obstructive pulmonary disease.
The mouth can serve as a reservoir of
infection for potential respiratory pathogens in high-risk patients, for
example those admitted to intensive care units of hospitals or nursing
homes. Bacteria recognized as potential respiratory pathogens (PRPs) have
been routinely cultured from the dental plaque of these subjects. It is
possible that these organisms can be aspirated into the lower airway to
cause infection.
The most provocative evidence that
dental plaque plays a role in the etiology of pneumonia comes from several intervention
studies that found a reduction in respiratory infection
following improvements in oral hygiene in high-risk subjects. One
prospective, randomized, double-blind, placebo-controlled clinical trial
found that patients given oral topical 0.12% chlorhexidine gluconate had a
reduced rate of pneumonia (by 65%) in contrast to control group given a
placebo. Other studies have found that dental plaque colonization by PRPs
and a higher dental plaque score on admission to the intensive care unit
predicted the onset of pneumonia within 15 days. Studies of nursing home
patients demonstrate that simple mechanical tooth brushing supplemented
with mouth irrigation with an iodine solution significantly reduces the
rate of pneumonia. These studies suggest that oral disinfection shows
promise as a simple and inexpensive strategy for reducing the rate of
pneumonia in high-risk people.
The available evidence suggests that poor oral hygiene results in the
formation of extensive oral biofilms (plaque) and promotes oral colonization by
potential respiratory pathogens. Pneumonia is a very prevalent disease,
causing 100,000 deaths in the United States each year. A significant
proportion of the general population (~10%) and an even greater proportion of
older people (~50%) have destructive periodontal disease. People with
destructive periodontal disease are most affected by pneumonia. Hence, even a modest effect of
poor oral health on pneumonia would have great public health implications.
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Historical Document
Page last reviewed: February 2, 2005
Content source:
Division of Oral Health,
National Center for Chronic Disease Prevention and
Health Promotion |
