Oral & Respiratory Status of Retarded/Disabled Persons

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DESCRIPTION (provided by applicant): Respiratory tract infections are the primary causes of death in institutionalized mentally retarded and developmental disabled (MRDD) persons. Aspiration of contaminated oral secretions is a major cause of respiratory infections and oral colonization by pathogenic bacteria resulting from inadequate oral hygiene has been shown to be routine in other high-risk populations. MRDD patients have similar risk factors for oral respiratory pathogen colonization as critically ill and nursing home patients, including dry mouth and poor oral hygiene. Poor oral status may be common in institutionalized MRDD patients, a significant health disparity, and it is not known if their oral cavities become colonized with pathogenic respiratory organisms. We thus propose to conduct exploratory research to fill this gap in knowledge, evaluate measures and methodology, and provide pilot data for a properly powered clinical trial. This developmental/exploratory research seeks to answer the following questions in institutionalized MRDD patients: 1. What is the oral status of institutionalized MRDD patients? 2. What is the prevalence of oral respiratory pathogen colonization? 3. What species and quantity of respiratory pathogens colonize the oral cavity in this population? 4. Is poor oral status associated with oral respiratory pathogen colonization? 5. Is poor oral status and respiratory pathogen colonization associated with respiratory infection? We will conduct an exploratory study of 220 institutionalized MRDD patients at four facilities. Oral examinations and sample collection will be performed at baseline and then monthly until the end of month six. PCR analysis will be performed on all teeth and tongue samples collected from these 200 subjects. We will also monitor the incidence of respiratory tract infections over the 6-month period. The primary outcomes will be prevalence of respiratory pathogen colonization, and the types and quantities of pathogens as determined by PCR analysis of microbiological samples. Explanatory variables will include Plaque, Gingivitis, and Oral Hygiene Indices, co-morbidities, and professional and routine oral care. Secondary outcomes will be the association of oral status and respiratory pathogen colonization with respiratory tract infections including pneumonia over the 6-month reporting period. The proposed study will test measures and methodology and will provide pilot data for sample size estimation for a full clinical trial.