Reducing aspiration pneumonia in dysphagic adults: Baseline and 30-day findings

Background: Aspiration pneumonia (AP) is an important problem for institutionalized-elderly. Patients with oropharyngeal-dysphagia (OD) have greater AP risk due to frequent aspiration of material containing pathogenic microorganisms. Several oral-health factors, including plaque, caries, and periodontal-disease are important risk variables for developing AP, the mouth being a reservoir for respiratory pathogens.

Objectives: To determine the effectiveness of a suction-toothbrush on oral-health status (30-day) and pneumonia incidence (1-year) for OD adults in long-term-care.

Methods: All residents with OD in one institution (n=30) were invited to participate in this single-blind, pilot RCT. Prior to study initiation, all caregivers attended sessions on daily mouthcare. Study interventions included baseline exam, professional debridement, timed-daily-mouthcare, and a 30-day follow-up exam. Subjects were randomly assigned to suction or manual toothbrush groups.

Results: 22 subjects meeting inclusion-criteria had a mean age of 54.3±14.7yrs, were mostly female (54.5%), and averaged 23.3±6.1 teeth. Oral health status at baseline and the subsequent change at 30-day follow-up examination were as follows: PlI=2.9±0.8 and 1.0±0.2; CI=1.1±0.6 and 0.2±0.2; GI=1.7±0.4 and 0.9±0.3; and mean PD=3.3±0.4mm and 2.6±0.4mm. Test and control groups did not differ significantly in any baseline parameter. The degree and percentage of subjects showing improvement for the oral health indexes were as follows: PlI=1.9±0.8/100%; CI=0.9±0.5/100%; GI=0.8±0.3/100%. The mean decrease in PD was 0.6±0.4mm with 95.5% improved. The improvement shown by test and control was not significantly different.

Conclusion: An intensified-daily-mouthcare program improved oral-health parameters. Clinically important improvements were obtained by all subjects, and the degree of improvement obtained with a novel suction toothbrush design did not differ significantly from that produced by a manual toothbrush. Given that the mouth can serve as a reservoir for respiratory pathogens, and that the risk of AP is highest amongst OD patients, these findings support an expectation of reduced AP incidence as a result of the program.