|by Dr.Richard Mao, D.M.D.
A recent article in the Journal
of Periodontology highlighted an interesting potential relationship between pathogenic
bacteria in the oral cavity which results in periodontal diseases and their relationship
to bacterial pneumonia in compromised patients. With more and more bacteria showing
antibiotic resistance, it becomes increasingly important to adequately identify and
control the known sources of bacterial contamination in patients that suffer from both
periodontal diseases and pulmonary diseases.
In the review article "Relationships Between
Periodontal Disease and Bacterial Pneumonia," by Scannapieco and Mylotte, they review
the literature indicating that a number of respiratory pathogens identified in multiple
case reports correspond to known periodontal disease causing organisms. Most periodontal
diseases are chronic infections of the tissues surrounding the teeth. The infections are
generally of mixed bacterial origin, with the major pathogens being gram negative
anaerobes. The soft tissue and bone destruction associated with periodontitis is the
leading cause of tooth loss in adults. This chronic infection is known to be exacerbated
by various medical conditions such as diabetes and sex hormone fluctuations and also has
recently been implicated as a potential risk factor in complications resulting from
cardiovascular diseases, diabetes and pregnancy.
In a series of clinical studies these trends were
reinforced when MICU patients in both a VA and community hospital setting were
retrospectively studied both in terms of their respiratory infections and oral bacterial
In addressing strategies to deal with reducing the risk
of respiratory infections resulting from periodontal pathogens, the authors reviewed the
limitations of current oral disinfection techniques and concluded by saying that
"fastidious infection control remains the cornerstone of prevention. Surveillance of
potential pathogens, identification of high risk patients, staff education, ... all have
had a positive impact on diminishing nosocomial pneumonia. Additional attention to oral
hygiene may further diminish the risk of nosocomial pneumonia."
Additional studies to evaluate the effects of improved
dental care and periodontal management of disease in patients who are at high risk for
pulmonary diseases is certainly appropriate. We have communicated this information to
local pulmonary specialists in hopes that they will appreciate, as we do, the importance
of good oral health to patients' medical health including their pulmonary status.