Highlighted review: Mouth care for preventing pneumonia in nursing homes

Chang Liu, Yubin Cao, Jie Lin, Linda Ng, Ian Needleman, Tanya Walsh, Chunjie Li

Plain language summary: Mouth care for preventing pneumonia in nursing homes

Review question
Does oral (mouth) care cut down pneumonia (a lung infection) in nursing homes?

We aimed to summarise the findings from studies known as 'randomised controlled trials' in order to identify whether mouth care helped prevent pneumonia in elderly people living in nursing homes or other care facilities, and which approach to mouth care was best.

Background
Pneumonia is common among elderly people living in nursing homes. Nursing home‐acquired pneumonia (NHAP) is a bacterial infection of the lung that occurs in residents of long‐term care facilities and nursing homes. Poor oral hygiene is considered to contribute to the likelihood of contracting an infection.

Professional mouth care is a combination of brushing teeth and mucosa, cleaning dentures, using mouthrinse, and check‐up visits to a dentist, while usual mouth care is generally less intensive, and is self‐administered, or provided by nursing home staff without special training in oral hygiene.

Study characteristics
This review was carried out through Cochrane Oral Health. We searched scientific databases for relevant studies, up to 15 November 2017. We included four studies, with a total of 3905 participants randomly assigned to treatment or usual care.

Participants were long‐term‐care elderly residents in nursing homes who did not have pneumonia at the beginning of the studies. Some of the participants had dementia or systemic diseases.

All studies focused on the comparison between 'professional' mouth care and 'usual' mouth care. None of the studies evaluated oral care versus no oral care.

Key results
We identified four studies, all of which compared professional mouth care to usual mouth care in nursing home residents.

From the limited evidence, we could not tell whether professional oral mouth care was better or worse than usual mouth care for preventing pneumonia. The evidence for death from any cause was inconclusive, but the studies did suggest that professional mouth care may reduce the number of deaths caused by pneumonia, compared to usual mouth care, when measured after 24 months.

Only one study measured negative effects of the interventions, and reported that there were no serious events. The most common non‐serious events reported were damage to the mouth and tooth staining.

Quality of the evidence
The quality of the evidence is low or very low, because of the small number of studies and problems with their design. Therefore, we cannot rely on the findings, and further research is required.

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Citation: Liu  C, Cao  Y, Lin  J, Ng  L, Needleman  I, Walsh  T, Li  C. Oral care measures for preventing nursing home‐acquired pneumonia. Cochrane Database of Systematic Reviews 2018, Issue 9. Art. No.: CD012416. DOI: 10.1002/14651858.CD012416.pub2.