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The Impact of Regular Dental Hygiene on Preventing Hospital-Acquired Pneumonia: A Meta-Analysis Review

A comprehensive meta-analysis published today in JAMA Internal Medicine indicates that consistent oral hygiene by hospitalized patients, specifically daily tooth brushing, effectively reduces the risk of hospital-acquired pneumonia (HAP). The most profound effects were noted in patients undergoing mechanical ventilation.

HAP, representing the most prevalent and lethal nosocomial infection, is discovered in approximately 1% of all hospital patients, ventilated or otherwise. The inception of HAP is generally traced back to microaspiration or macroaspiration of oral microbes. However, the use of chlorhexidine-containing mouthwashes to mitigate oral microbial load has been steeped in controversy. In such a scenario, rigorous tooth brushing is considered to be both safer and more effective than oral antiseptics.

Despite its benefits, prevention guidelines have not traditionally underlined the importance of tooth brushing. Consequently, the practice of oral care during hospital stays varies significantly across different healthcare settings.

The authors of the study scrutinized 15 randomized clinical trials, involving 2,786 valid participants. The trials explored the relationship between outcomes and oral care habits among hospital patients. Of the studies reviewed, all except one looked at patients receiving treatment in intensive care units (ICUs).

Substantial data from these studies revealed that toothbrushing significantly reduced the risk of HAP (risk ratio [RR]: 0.67) and ICU mortality rates (RR: 0.81). Similarly, it led to a decrease in ventilator-associated pneumonia rates (RR: 0.68), expedited the extubation process (mean difference: 1.24 days), and reduced ICU stays (mean difference: −1.78 days). Interestingly, an 85% decrease in non-ventilator HAP cases was observed in one study, highlighting a significant result.

These compelling findings propose that routine tooth brushing should be integrated into the standard care protocol for hospitalized patients.

In an accompanying commentary, Rupak Datta, MD, emphasized the valuable contributions of this research to the infection prevention field. He reiterated the importance of tooth brushing for ventilated patients but also noted limited data related to non-ventilator HAP patients. Further strengthening of infection prevention efforts was also encouraged by the World Health Organization (WHO) through universal masking in healthcare facilities and increased protection for health workers.

Increasingly, public health leaders are echoing the vital significance of ensuring daily toothbrushing in hospitalized patients, especially those undergoing mechanical ventilation, with the ultimate goal of minimizing pneumonia and significantly lowering mortality rates.

Source: https://www.cidrap.umn.edu/pneumonia/daily-hospital-toothbrushing-may-reduce-pneumonia

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