Oral care measures for preventing nursing home-acquired pneumonia

Cao Y, Liu C, Lin J, Ng L, Needleman I, Walsh T, Li C

Does taking care of the mouths and teeth of nursing home residentsĀ help prevent pneumonia?*

What is nursing home-acquired pneumonia?

Nursing home-acquired pneumonia (NHAP) is a bacterial infection of the lung occurring in residents of long-term care facilities and nursing homes.

What measures can be taken to prevent nursing home-acquired pneumonia?

People with poor oral hygiene may be more likely to contract an infection. Professional oral care is a combination of brushing teeth and gums, cleaning false teeth, using mouthrinse, and attending check-up visits with a dentist. Usual oral care is self-administered or provided by nursing home staff without special training in oral hygiene.

What did we want to find out?

We wanted to find out whether oral care reduces NHAP. We also wanted to find out whether oral care reduces the number of deaths (from pneumonia and from any cause) among residents of care homes or other long-term care facilities.

What did we do?

We searched scientific databases and trials registers for randomised controlled trials on oral care in residents of care homes. Randomised controlled trials are considered to provide the most reliable scientific evidence because participants are randomly assigned to their treatment groups. We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes.

What did we find?

We found six relevant studies, with a total of 6244 participants, who were randomly assigned to professional or usual oral care. Three studies were carried out in Japan, two in the USA, and one in France. Participants were nursing home residents who did not have pneumonia at the beginning of the studies. Some participants had dementia or systemic diseases such as chronic lung diseases, stroke, or heart failure. Usual care varied but was simple, self-administered care with no help from a dental professional or nursing home staff member trained in oral care.

No studies compared oral care to no oral care.

From the limited evidence, we could not determine whether professional mouth care was better or worse than usual oral care for preventing pneumonia, death from pneumonia, or death from any cause. However, two studies that observed nursing home residents for two years suggested that professional mouth care may reduce the number of deaths caused by pneumonia.

Only one study measured negative side effects of professional oral care, and reported no serious events. The most common minor side effects were damage to the mouth and tooth staining.

What are the limitations of the evidence?

We found only a small number of studies, which varied in the methods they used (e.g. how and when results were measured and the type of professional oral care that was provided). Therefore, we are not confident in the findings, and further research is required.

How up to date is this evidence?

This evidence is up to date to 30 June 2022.

*This article is based on the Plain Language Summary of the review. You can read the review here: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012416.pub3/full