By Dr. Nurul Izyan Zainuddin, Dr. Mohd. Zamri Hussin
Have you been admitted to hospitals, but insisted on brushing your teeth twice daily, despite feeling weak and tired? You probably have done something that your future self will thank you for. Good oral hygiene practice is not just needed to maintain healthy teeth; it can also save lives!
Recent studies have underscored the importance of regular tooth brushing in preventing severe infections, particularly hospital-acquired pneumonia, a lung infection that can develop when harmful bacteria from the mouth are inhaled or migrate into the lungs. The findings are especially relevant for long-term hospital patients, those with physical limitations, and individuals in intensive care units (ICUs), where maintaining oral hygiene can be challenging.
A Harvard-led study, published in JAMA Internal Medicine, reveals that seriously ill patients in intensive care units (ICUs) or on ventilator support are significantly less likely to develop hospital-acquired pneumonia (HAP) if their teeth are brushed daily. These patients also need ventilators for less time, can leave the ICU sooner, and are less likely to succumb to death compared to those without a similar toothbrushing routine. These findings underscore what many oral health professionals have long suspected: the state of our mouths can have far-reaching implications for our overall health, especially when we are at our most vulnerable, making prevention and early treatment crucial in hospital care.
To understand why this connection exists, we need to look into the complex ecosystem of human oral cavity. Far from being a simple cavity, the mouth is home to over 700 different species, including bacteria, viruses, fungi and other microbes. When we are healthy, this diverse microbiome exists in a delicate balance, and plays a crucial role in our wellbeing, aiding in digestion and even supporting our immune system. However, the stress of hospitalisation, combined with factors like medications, reduced saliva flow, and the inability to maintain regular oral hygiene, can quickly disrupt this delicate balance.
When harmful bacteria are allowed to proliferate unchecked in the mouth, these pathogens can be aspirated into the lungs, leading to pneumonia – a particular risk for patients on ventilators since the breathing tube inserted into the throat can carry bacteria farther down the airway. Additionally, bacteria can enter the bloodstream through inflamed or bleeding gum tissue, potentially causing systemic infections. For patients with weakened immune systems, the consequences of hospital-acquired pneumonia can be severe as it can lead to various complications e.g. respiratory failure, sepsis, or multi-organ failure, and is usually more resistant to antibiotics.
This is where the humble act of toothbrushing becomes a powerful preventive measure. The mechanical action of toothbrushing helps by disrupting and removing sticky dental plaque biofilm where bacteria thrive. It is not just about removing food particles; the mechanical action of brushing breaks up bacterial colonies before they can reach unhealthy levels. In this regard, mouth rinsing alone can’t effectively dislodge the bacteria. Moreover, the act of brushing stimulates saliva production which contains enzymes that help maintain oral health and neutralise harmful bacteria.
To address the critical need for improved oral care in preventing hospital-acquired infections, we propose several multidisciplinary strategies. First, oral health checks should be integrated into standard hospital admission procedures, similar to how vital signs are routinely assessed. Evaluating a patient’s oral health as part of their initial assessment would ensure early detection of potential issues.
Next, we recommend the creation of tailored oral care protocols to suit various patient needs. These guidelines should cover care frequency, suitable products, and techniques based on the patient’s ability. In addition to this, it is essential to provide comprehensive training for healthcare providers, especially nursing staff, on the importance of oral health. Proper training will equip them with the necessary skills for effective oral care, particularly for ventilated patients and those with special needs.
Moreover, hospitals should invest in specialized oral care equipment, such as suction toothbrushes for patients at risk of aspiration, moisturising gels, and appropriate antimicrobial mouth rinses. These tools can significantly enhance the quality of care for patients experiencing dry mouth or at risk of infection.
Regular oral health assessments should also be carried out throughout a patient’s hospital stay, with established pathways for referrals to dental specialists when more complex issues arise. Finally, patient and family education is crucial in maintaining oral hygiene during hospitalization. This could be achieved through instructional videos, printed guides, and hands-on demonstrations to ensure that everyone involved understands the importance of oral care in the recovery process.
The benefits of good oral health extend beyond infection prevention. Proper oral care can significantly improve a patient’s comfort and quality of life during a hospital stay. The ability to eat comfortably, speak clearly, and interact without the discomfort of poor oral health can have a positive impact on a patient’s overall wellbeing and recovery.
Thus, the mouth should no longer be seen as separate from the rest of the body. For healthcare providers at hospitals, it should be understood that integrating comprehensive oral care into hospital protocols is not just about maintaining clean teeth – it is about preventing life-threatening complications and potentially saving lives.
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