The oral cavity is an environment that consists of numerous species of microorganisms (both bacterial and fungal) together with their biofilms and cytokines (chemicals). Most of these organisms are beneficial and are thus termed normal flora. In cases of poor hygiene, the oral cavity is invaded by disease causing organisms which increase the risk of aspirating in bedridden individuals. In this article we discuss the relationship between oral care and aspiration pneumonia.
The risk of suffering from aspiration pneumonia is significantly increased in the presence of oral cavity diseases such as dental caries and periodontal disease. This is mainly because of the existence of pockets of infections where bacterial organisms are trapped. Other conditions that are also known to increase this risk include inability to feed, the use of nasogastric tube feeding, swallowing difficulties and poor motor function.
Research shows that at least 15% of adults in the general population have some degree of dysphagia (difficulty in swallowing). Among persons aged at least 80 years the problem has been demonstrated in at least half of them. The contributing factors for this problem are the physiological and anatomical changes that take place in the oropharynx as we advance in age. Apart from age, conditions such as stroke, dementia and cerebral palsy also contribute to the problem.
One of the interventions that have been shown to lower the risk of aspirating is a change in feeding posture. The position that is chosen should be less than 90 degrees from the horizontal plane. There is a need for the caregiver and the patient to be taken through maneuvers that can be adopted to reduce this risk as much as possible. Several sessions of training are typically needed.
It is not uncommon for patients that are undergoing long term care to have numerous prescriptions due to the existence of many illnesses and medical conditions. Some of the medications commonly used among this group of patients have been shown to have inhibitory effects on swallowing. Frequent evaluations need to be undertaken to determine which drugs may have such effects. Drugs that may have to be added are those that will help reduce secretions and gastric acid production.
Due to the reduced level of consciousness, many of the elderly patients in care tend to have suppressed oral functions as well. The oral cavity tends to become abnormally dry and mucus and saliva are produced in greater quantities as a reflex action. The secretions that produced mix with solid residues forming a sticky paste on the teeth and mucosal surfaces in the mouth.
With self-cleaning mechanisms of the oral cavity suppressed, there is a need to artificially remove this sticky paste from the cavity. If this is not done, the area will be colonized by harmful bacteria that can easily cause upper respiratory tract infections and aspiration pneumonia. Gram negative bacteria are the most commonly isolated organisms in such settings. Even if overt aspiration does not occur, silent aspiration of microorganisms may cause pneumonia.
Maintaining good oral health will not only lower the risk of aspiration but that of other local and systemic complications as well. Such may include abscess formation and infective endocarditis. It is important to bear in mind that the elderly are at an increased risk of poor hygiene and aspiration due to multiple factors. Preventing aspiration is done through eliminating as many of the risk factors as possible.
The risk of suffering from aspiration pneumonia is significantly increased in the presence of oral cavity diseases such as dental caries and periodontal disease. This is mainly because of the existence of pockets of infections where bacterial organisms are trapped. Other conditions that are also known to increase this risk include inability to feed, the use of nasogastric tube feeding, swallowing difficulties and poor motor function.
Research shows that at least 15% of adults in the general population have some degree of dysphagia (difficulty in swallowing). Among persons aged at least 80 years the problem has been demonstrated in at least half of them. The contributing factors for this problem are the physiological and anatomical changes that take place in the oropharynx as we advance in age. Apart from age, conditions such as stroke, dementia and cerebral palsy also contribute to the problem.
One of the interventions that have been shown to lower the risk of aspirating is a change in feeding posture. The position that is chosen should be less than 90 degrees from the horizontal plane. There is a need for the caregiver and the patient to be taken through maneuvers that can be adopted to reduce this risk as much as possible. Several sessions of training are typically needed.
It is not uncommon for patients that are undergoing long term care to have numerous prescriptions due to the existence of many illnesses and medical conditions. Some of the medications commonly used among this group of patients have been shown to have inhibitory effects on swallowing. Frequent evaluations need to be undertaken to determine which drugs may have such effects. Drugs that may have to be added are those that will help reduce secretions and gastric acid production.
Due to the reduced level of consciousness, many of the elderly patients in care tend to have suppressed oral functions as well. The oral cavity tends to become abnormally dry and mucus and saliva are produced in greater quantities as a reflex action. The secretions that produced mix with solid residues forming a sticky paste on the teeth and mucosal surfaces in the mouth.
With self-cleaning mechanisms of the oral cavity suppressed, there is a need to artificially remove this sticky paste from the cavity. If this is not done, the area will be colonized by harmful bacteria that can easily cause upper respiratory tract infections and aspiration pneumonia. Gram negative bacteria are the most commonly isolated organisms in such settings. Even if overt aspiration does not occur, silent aspiration of microorganisms may cause pneumonia.
Maintaining good oral health will not only lower the risk of aspiration but that of other local and systemic complications as well. Such may include abscess formation and infective endocarditis. It is important to bear in mind that the elderly are at an increased risk of poor hygiene and aspiration due to multiple factors. Preventing aspiration is done through eliminating as many of the risk factors as possible.
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