Pneumonia is common among elderly people living in nursing homes. Nursing home‐acquired pneumonia (NHAP) is a bacterial infection of the lung that occurs in residents of long‐term care facilities and nursing homes. Poor oral hygiene is considered to contribute to the likelihood of contracting an infection. Professional mouth care is a combination of brushing teeth and mucosa, cleaning dentures, using mouthrinse, and check‐up visits to a dentist, while usual mouth care is generally less intensive, and is self‐administered, or provided by nursing home staff without special training in oral hygiene.
What was the research?
A systematic review to examine whether mouth care cuts down lung infections in nursing homes. We aimed to identify whether mouth care helped prevent pneumonia in elderly people living in nursing homes or other care facilities, and which approach to mouth care was best.
Who conducted the research?
The research was conducted by a team led by Chang Liu of West China Hospital of Stomatology, Sichuan University, China, on behalf of Cochrane Oral Health. Yubin Cao, Jie Lin, Linda Ng, Ian Needleman, Tanya Walsh and Chunjie Li were also on the team.
What evidence was included in the review?
We searched scientific databases for relevant studies, up to 15 November 2017. We included 4 randomised controlled trials, with a total of 3,905 participants, randomly assigned to treatment or usual care. Participants were long‐term‐care elderly residents in nursing homes who did not have pneumonia at the beginning of the studies. Some of the participants had dementia or systemic diseases. All studies focused on the comparison between ‘professional’ mouth care and ‘usual’ mouth care. None of the studies evaluated oral care versus no oral care.
What did the evidence say?
From the limited evidence, we could not tell whether professional oral mouth care was better or worse than usual mouth care for preventing pneumonia. The evidence for death from any cause was inconclusive, but the studies did suggest that professional mouth care may reduce the number of deaths caused by pneumonia, compared to usual mouth care, when measured after 24 months.
Only one study measured negative effects of the interventions, and reported that there were no serious events. The most common non‐serious events reported were damage to the mouth and tooth staining.
How good was the evidence?
The quality of the evidence is low or very low, because of the small number of studies and problems with their design. Therefore, we cannot rely on the findings, and further research is required.
What are the implications for dentists and the general public?
Low‐quality evidence suggested that professional oral care may reduce mortality due to pneumonia compared to usual care, when measured at 24 months. Low‐quality evidence was inconclusive about the effects of professional care compared to usual oral care on incidence of nursing‐home acquired pneumonia, number of first episodes of nursing‐home acquired pneumonia, and mortality from any cause. The only study to measure adverse effects reported that there were no serious adverse effects. We found no high‐quality evidence to determine which oral care measures are most effective for reducing nursing home‐acquired pneumonia. Further trials are needed to draw reliable conclusions.
What should researchers look at in the future?
Considering the limited number of trials in this field, there is a need for more trials focusing on the effect of oral care measures on nursing home‐acquired pneumonia (NHAP) prevention.
Liu C, Cao Y, Lin J, Ng L, Needleman I, Walsh T, Li C. Oral care measures for preventing nursing home‐acquired pneumonia. Cochrane Database of Systematic Reviews 2018, Issue 9. Art. No.: CD012416. DOI: 10.1002/14651858.CD012416.pub2.
This post is an extended version of the review’s plain language summary, compiled by Anne Littlewood at the Cochrane Oral Health Editorial Base.