The oral cavity is an environment that consists of numerous species of microorganisms (both bacterial and fungal) together with their biofilms and cytokines (chemicals). Most of these organisms are beneficial and are thus termed normal flora. In cases of poor hygiene, the oral cavity is invaded by disease causing organisms which increase the risk of aspirating in bedridden individuals. In this article we discuss the relationship between oral care and aspiration pneumonia.
If a patient on long term care has concomitant oral cavity disease, their risk of suffering from aspiration is significantly increased. Some of these diseases include dental caries and periodontal disease. Other conditions which may not necessarily be in the mouth but also increase this risk include difficulties in feeding and swallowing, poor motor coordination and nasogastric tube feeding. The risk of having these conditions is highest among the elderly.
Findings from various studies show that approximately 15% of adults within the general population have difficulties in swallowing. This problem appears to worsen with advancing age such that among those aged above 80 years, the proportion approaches 50%. It is thought that these challenges arise due to the changes occurring in the oropharynx as one advances in age. Other factors that may increase the risk include cerebral palsy, stroke and dementia among others.
One of the most effective interventions that can be undertaken is to take care of the posture of these patients when they are swallowing. This is done with the help of a posture and swallowing therapist. The patient and their care taker need to be taught the maneuvers that they can perform during swallowing so as to minimize the risk as much as possible.
The numerous medications that are prescribed for this group of patients may in some cases inhibit the swallowing reflex. For this reason all drugs need to be carefully considered with regard to their effect on swallowing. Other interventions that may be undertaken include dietary modification, administration of medications to reduce gastric acid secretion (proton pump inhibitors) and to minimize the secretions by giving drugs such as angiotensin converting enzymes.
Suppression of oral functions is common in patients on care. The causes behind this are the depressed consciousness and the presence of feeding tubes. A lot of saliva and mucous secretions are produced at this point to help and deal with the problem. Unfortunately, these secretions mix with solid residues in the mouth to form a sticky paste that will be seen adhering to the mucosal surfaces and teeth.
With self-cleaning mechanisms of the oral cavity suppressed, there is a need to artificially remove this sticky paste from the cavity. If this is not done, the area will be colonized by harmful bacteria that can easily cause upper respiratory tract infections and aspiration pneumonia. Gram negative bacteria are the most commonly isolated organisms in such settings. Even if overt aspiration does not occur, silent aspiration of microorganisms may cause pneumonia.
Proper oral hygiene for elderly clients in long term care facilities is a vital step in the prevention of aspiration as well as other associated complications. Some of the complications that may be encountered if this is not done regularly include infective endocarditis and abscess formation. Apart from regular cleaning of the oral cavity, other risk factors of aspiration need to be reduced as much as possible.
If a patient on long term care has concomitant oral cavity disease, their risk of suffering from aspiration is significantly increased. Some of these diseases include dental caries and periodontal disease. Other conditions which may not necessarily be in the mouth but also increase this risk include difficulties in feeding and swallowing, poor motor coordination and nasogastric tube feeding. The risk of having these conditions is highest among the elderly.
Findings from various studies show that approximately 15% of adults within the general population have difficulties in swallowing. This problem appears to worsen with advancing age such that among those aged above 80 years, the proportion approaches 50%. It is thought that these challenges arise due to the changes occurring in the oropharynx as one advances in age. Other factors that may increase the risk include cerebral palsy, stroke and dementia among others.
One of the most effective interventions that can be undertaken is to take care of the posture of these patients when they are swallowing. This is done with the help of a posture and swallowing therapist. The patient and their care taker need to be taught the maneuvers that they can perform during swallowing so as to minimize the risk as much as possible.
The numerous medications that are prescribed for this group of patients may in some cases inhibit the swallowing reflex. For this reason all drugs need to be carefully considered with regard to their effect on swallowing. Other interventions that may be undertaken include dietary modification, administration of medications to reduce gastric acid secretion (proton pump inhibitors) and to minimize the secretions by giving drugs such as angiotensin converting enzymes.
Suppression of oral functions is common in patients on care. The causes behind this are the depressed consciousness and the presence of feeding tubes. A lot of saliva and mucous secretions are produced at this point to help and deal with the problem. Unfortunately, these secretions mix with solid residues in the mouth to form a sticky paste that will be seen adhering to the mucosal surfaces and teeth.
With self-cleaning mechanisms of the oral cavity suppressed, there is a need to artificially remove this sticky paste from the cavity. If this is not done, the area will be colonized by harmful bacteria that can easily cause upper respiratory tract infections and aspiration pneumonia. Gram negative bacteria are the most commonly isolated organisms in such settings. Even if overt aspiration does not occur, silent aspiration of microorganisms may cause pneumonia.
Proper oral hygiene for elderly clients in long term care facilities is a vital step in the prevention of aspiration as well as other associated complications. Some of the complications that may be encountered if this is not done regularly include infective endocarditis and abscess formation. Apart from regular cleaning of the oral cavity, other risk factors of aspiration need to be reduced as much as possible.
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