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.
It has been shown through research that close to 15% of adults have swallowing difficulties. This figure appears to increase as we advance in age due to what are believed to be changes taking place in the physiology and anatomy of the oropharynx. At the age of 80 years, it appears that almost half of the people have varying degrees of swallowing challenges. Other factors that may contribute to the problem include stroke, cerebral palsy and dementia among others.
One of the most important interventions that should be considered is a change in posture during swallowing. A posture that will reduce the risk of aspiration should be adopted. In general, this should be less than 90 degrees from the horizontal. Additional maneuvers that are aimed at optimizing on this can be taught to both the patient and their caregiver over several sessions.
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.
Suppression of oral functions is common in patients on care. The causes behind this are the depressed consciousness and the presence of feeding tubes. A lot of saliva and mucous secretions are produced at this point to help and deal with the problem. Unfortunately, these secretions mix with solid residues in the mouth to form a sticky paste that will be seen adhering to the mucosal surfaces and teeth.
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.
It has been shown through research that close to 15% of adults have swallowing difficulties. This figure appears to increase as we advance in age due to what are believed to be changes taking place in the physiology and anatomy of the oropharynx. At the age of 80 years, it appears that almost half of the people have varying degrees of swallowing challenges. Other factors that may contribute to the problem include stroke, cerebral palsy and dementia among others.
One of the most important interventions that should be considered is a change in posture during swallowing. A posture that will reduce the risk of aspiration should be adopted. In general, this should be less than 90 degrees from the horizontal. Additional maneuvers that are aimed at optimizing on this can be taught to both the patient and their caregiver over several sessions.
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.
Suppression of oral functions is common in patients on care. The causes behind this are the depressed consciousness and the presence of feeding tubes. A lot of saliva and mucous secretions are produced at this point to help and deal with the problem. Unfortunately, these secretions mix with solid residues in the mouth to form a sticky paste that will be seen adhering to the mucosal surfaces and teeth.
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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