Link between Periodontitis and Aspiration Pneumonia

Over the last several decades, dentistry as a branch of comprehensive healthcare has come a very long way with great technological innovations, higher-quality education, and advanced levels of scientific research. As dentistry has evolved, modern research within the field has come to find that poor oral health does in fact have a link to several other systemic conditions and diseases such as diabetes mellitus, cardiovascular disease, pre-term birth, chronic inflammation associated with cancer, and respiratory diseases. In individuals who don’t routinely see a dentist, in conjunction with inadequate oral homecare, the consequences of poor oral hygiene are often overlooked until a serious health problem occurs. In high-risk populations like the elderly or those in long-term care facilities, pathogenic microorganisms that harbor in the oral cavity due to a lack of routine oral hygiene care, both at home and in the dental office, have the potential to cause life-threating conditions. This paper briefly discusses some of the research that has explored the association between periodontal disease and the role it plays in causing serious respiratory infections such as pneumonia.

I would assume that mostly all dental professionals have heard the phrase, “the mouth is a mirror of the body.” The connection between oral-systemic diseases is not a new topic within the field of dentistry and it was established long ago that oral health plays a significant role in achieving general health and well-being (Beemsterboer, 2017). In a 2011 cross-sectional study published in the Journal of Periodontology, researchers found there to be a strong positive correlation between periodontal disease and the development of upper respiratory diseases such as acute bronchitis, COPD, and pneumonia. This study was completed to examine and compare the periodontal health of healthy individuals to that of individuals who had been hospitalized with a respiratory infection. What this study ultimately found was that the people hospitalized with respiratory infections demonstrated significantly worse periodontal health overall. When looking at the data from the gingival index, plaque index, simplified oral hygiene index, probe readings, and clinical attachment levels between the two groups, the study suggests that there is a definite connection between respiratory infections and periodontal disease.

According to Kanzigg and Hunt (2016), pneumonia has the highest morbidity and mortality rate in the United States and accounts for 13-48% of all long-term care associated illnesses. Their article published in The Journal of Dental Hygiene explains that approximately 30-50% of hospital-acquired pneumonia (HAP) cases occur due to the aspiration of oral bacterial pathogens into the lungs. Because periodontal disease is more prevalent in elderly patients due to long-term stress on the dentition, they are more susceptible to developing HAP, especially if endotracheal intubation and mechanical ventilation are present. In elderly patients that have active periodontal disease, the progression of periodontal bacterial colonization in the throat and respiratory tract will likely be enhanced when routine oral hygiene is absent. It has been suggested that an oral hygiene protocol that was established by the Centers for Disease Control (CDC) be implemented in hospitals and long-term care facilities to reduce the risk of patients acquiring aspiration pneumonia. This protocol includes daily brushing, oral cleansing with swabs, and application of lip moisturizer (Kanzigg & Hunt, 2016).

A statement from the American Academy of Periodontology reads, “Research has found that bacteria that grow in the oral cavity can be aspirated into the lungs to cause respiratory diseases such as pneumonia, especially in people with periodontal disease.” Within the geriatric population that is vastly growing, it has been determined that aspiration pneumonia is the most common result of poor oral health in people of this older generation (Terpenning, 2005). The oral cavity has a complex mixture of gram negative anaerobic bacteria and facultative aerobes that can spiral out of control when oral hygiene is lacking. When plaque accumulates in the mouth over an extended period of time without being removed, harmful pathogenic bacteria start to replicate, colonize, and flourish, causing constant inflammation and destruction to the periodontium. As destruction to the teeth, bone, and surrounding tissues becomes more advanced, the severity of periodontal disease increases, therefore increasing the abundance of periodontal pathogens within the oral cavity. This is where the presence of periodontal disease becomes a problem for individuals in long-term care facilities with medical risk factors that include problems swallowing, decreased efficacy of lung defense mechanisms, impaired immune function, feeding position of Overall, it is obvious that the presence of generalized and even localized periodontal infections increase the risk of a person developing a debilitating respiratory infection that could be fatal. Based on the evidence from scientific studies, meticulous oral care in both elderly and long-term care patients with dental disease is required to effectively reduce the incidence of aspiration pneumonia. Research affirms that inadequate oral hygiene resulting in periodontal infections is a major contributor in the development of aspiration pneumonia. To prevent the incidence of respiratory infections in these high-risk populations, is it critical that healthcare providers within these long-term care facilities provide patients with basic oral care involving interdental cleaning, toothbrushing, and rinsing of the mouth with antimicrobial rinses. Because dental hygiene is not currently practiced in these facilities, the prevention and maintenance of active periodontal disease is essential for avoiding respiratory complications. In conjunction with in-house caregivers providing oral health care, plaque and calculus control procedures eventually need to be provided to these patients by dental professionals on a regular basis (Terpenning, 2005).  

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