Professional oral health care prevents mouth-lung infection in long-term care homes: a systematic review.
Michelle J Marusiak, Michael Paulden, Arto Öhinmaa
Abstract
Background: Nursing home-acquired pneumonia (NHAP) is the leading cause of mortality among residents in long-term care (LTC) homes. Aspiration pneumonia (AP) is one cause of NHAP. Professional oral health care (POHC) and daily mouth care can be effective in decreasing AP risk. Aim: To identify, appraise, synthesize, analyze, and interpret results on the effectiveness of onsite POHC interventions/programs delivered to LTC home residents in reducing oral disease and NHAP. To summarize the findings and provide recommendations for clinical work and future research. Methods: The PICO question addressed was, "In LTC home residents with oral health needs (P), is onsite POHC (I), compared to usual care (C), clinically effective in reducing dental disease and pneumonia/AP (O)?" Databases searched were PubMed, EMBASE (Ovid), CINAHL (Ebsco), Cochrane Library (Wiley), Web of Science, and the databases of the Centre for Reviews and Dissemination. Included were randomized controlled trials (RCTs), non-RCTs, and cross-sectional studies. PRISMA guidelines were followed and GRADE was used to assess the quality of studies. Results: Thirteen clinical effectiveness studies were included: 10 RCTs, 1 non-RCT, and 2 cross-sectional studies. Discussion: Better oral health and respiratory infection outcomes were found in the experimental groups who received an onsite POHC intervention compared to the control groups. Conclusion: There is moderate-to-strong evidence that onsite POHC in LTC homes, provided mostly by dental hygienists, is effective in preventing bacterial mouth infection, pneumonia, and AP.