Good toothbrushing lowers pneumonia in hospitalized patients

Daily toothbrushing linked to lower rates of hospital-acquired pneumonia.

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Researchers discovered a simple and inexpensive toothbrush tool that may help reduce pneumonia rates in hospitalized patients. The study from Brigham and Women’s Hospital and Harvard Pilgrim Health Care Institute combined data from 15 trials involving over 2,700 patients. Daily toothbrushing is associated with lower rates of hospital-acquired pneumonia, particularly for patients on mechanical ventilation. The findings were published in JAMA Internal Medicine.

Corresponding author Michael Klompas, MD, MPH, hospital epidemiologist and an infectious disease physician in the Department of Medicine at BWH and Professor of Population Medicine at Harvard Pilgrim Health Care Institute, said, “The signal that we see here towards lower mortality is striking—it suggests that regular toothbrushing in the hospital may save lives. It’s rare in the world of hospital preventative medicine to find something like this that is both effective and cheap. Instead of a new device or drug, our study indicates that something as simple as brushing teeth can make a big difference.”

Hospital-acquired pneumonia happens when mouth bacteria enter a patient’s airways, infecting their lungs. Patients who are frail or have a weakened immune system are more at risk. The team wanted to see if daily toothbrushing could help. They reviewed studies worldwide, comparing regular oral care with toothbrushing to oral care without it. Daily toothbrushing may reduce the risk of hospital-acquired pneumonia by lowering mouth bacteria.

The team found daily toothbrushing is linked to a lower risk of hospital-acquired pneumonia and ICU mortality. For ICU patients, toothbrushing was also connected to fewer days of mechanical ventilation and a shorter ICU stay. Most studies in the review focused on tooth cleaning for adults in the ICU, with only two studies examining non-ventilated patients. The researchers hope toothbrushing benefits non-ICU patients, too, but more studies are needed to confirm this.

Klompas said, “The findings from our study emphasize the importance of implementing an oral health routine that includes toothbrushing for hospitalized patients. We hope our study will help catalyze policies and programs to ensure that hospitalized patients regularly brush their teeth. If a patient cannot perform the task themselves, we recommend a member of the patient’s care team assist.”

In conclusion, daily toothbrushing is a simple yet effective way to reduce the risk of pneumonia in hospitalized patients. The study showed that patients who brushed their teeth regularly had lower rates of hospital-acquired pneumonia, especially those in the Intensive Care Unit.

The findings suggest that maintaining good oral hygiene, even with a primary practice like toothbrushing, can benefit respiratory health in hospital settings. Further research is needed, especially for non-ICU patients. Still, the results emphasize the potential impact of this straightforward and affordable preventive measure.

Journal reference:

  1. Selina Ehrenzeller, Michael Klompas, et al., Association Between Daily Toothbrushing and Hospital-Acquired PneumoniaA Systematic Review and Meta-Analysis. JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2023.6638.

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