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Hospital-acquired pneumonia (HAP) is the leading cause of illness and death among hospitalized patients. This dangerous complication develops in approximately one out of every hundred patients in the hospital. A meta-analysis published in JAMA Internal Medicine examined the clinical impact of daily toothbrushing on pneumonia incidence among hospitalized individuals.
About the Meta-Analysis
Researchers analyzed 15 randomized controlled trials involving over 2,800 patients. Nearly 80% of them were hospitalized in intensive care units, and the rest were in other departments. Participants included patients with nasal and oral intubation, with about one-fifth undergoing tracheotomy.
In most studies, chlorhexidine was used in addition to or instead of tooth cleaning in both the intervention and control groups. Some studies used anti-plaque toothpaste, povidone-iodine, saline solution, or distilled water instead of chlorhexidine.
How Toothbrushing Affects Mortality
The results indicate that pneumonia incidence was more than a third lower among those who brushed their teeth daily. Patients on mechanical ventilation (MV) experienced a 30% reduction in pneumonia incidence, but this was not observed among those on invasive mechanical ventilation (IMV).
Two studies demonstrated a 70% reduced risk of pneumonia among patients who regularly brushed their teeth. Additionally, according to the majority of studies, there was a 20% decrease in mortality among patients in the intensive care unit (ICU).
Other Benefits of Regular Oral Hygiene
Patients spent less time on mechanical ventilation – on average, 1.2 days less – and 1.3-2 days less in the intensive care unit. Practicing toothbrushing twice a day was found to be as effective as more frequent cleaning.
Daily toothbrushing may be associated with significantly lower rates of HAP, lower rates of ICU mortality, shorter duration of mechanical ventilation, and shorter ICU length of stay.
Study authors
Researchers emphasize the importance of further studies to understand whether the type of toothpaste matter, or if cleaning the tongue or intestines is necessary. Since the authors believe that “policies and programs are needed to encourage daily tooth cleaning in hospitalized patients, especially those receiving lung mechanical ventilation.”
The importance of oral hygiene is increasingly becoming the focus of research. Recently, Japanese scientists demonstrated that cleaning teeth before bedtime is beneficial for preventing cardiovascular diseases.
