Pneumonia in nonambulatory patients - The role of oral bacteria and oral hygiene
Pneumonia in nonambulatory patients - The role of oral bacteria and oral hygiene
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DOI：
10.14219/jada.archive.2006.0400
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发表时间：
2006-10-01
影响因子：
3.9
通讯作者：
Scannapieco, Frank A.
中科院分区：
文献类型：
--
作者：
Scannapieco, Frank A.
背景有相当多的证据支持不良口腔健康、口腔微生物菌群和细菌性肺炎之间的关系，特别是住院患者的呼吸机相关性肺炎。牙齿或假牙有非脱落表面，其上形成口腔生物膜（即牙菌斑），易受呼吸道病原体定植。随后将从口腔生物膜脱落的呼吸道病原体吸入下呼吸道会增加发生肺部感染的风险。此外，患者可能会从发炎的牙周组织中吸入炎症产物进入下气道，导致肺损伤。作者回顾了实验室研究、临床试验和综述文章。许多研究表明，口腔可以被呼吸道病原体定殖，并作为这些生物体的储存库。其他研究表明，旨在控制或减少口腔生物膜的口腔干预措施可以降低高危人群患肺炎的风险。总之，有充分的证据表明，改善口腔卫生可以预防易感患者的肺炎。对住院患者和长期护理居民实行严格的口腔卫生方案可能会降低患肺炎的风险。
Background. Considerable evidence exists to support a relationship between poor oral health, the oral microflora and bacterial pneumonia, especially ventilator-associated pneumonia in institutionalized patients. Teeth or dentures have nonshedding surfaces on which oral biofilms (that is dental plaque) form that are susceptible to colonization by respiratory pathogens. Subsequent aspiration of respiratory pathogens shed from oral biofilms into the lower airway increases the risk of developing a lung infection. In addition, patients may aspirate inflammatory products from inflamed periodontal tissues into the lower airway, contributing to lung insult.Types of Studies Reviewed. The author reviewed laboratory studies, clinical trials and review articles.Conclusions. A number of studies have shown that the mouth can be colonized by respiratory pathogens and serve as a reservoir for these organisms. Other studies have demonstrated that oral interventions aimed at controlling or reducing oral biofilms can reduce the risk of pneumonia in high-risk populations. Taken together, the evidence is substantial that improved oral hygiene may prevent pneumonia in vulnerable patients.Clinical Implications. Institution of rigorous oral hygiene regimens for hospitalized patients and long-term-care residents may reduce the risk of developing pneumonia.