Dentures and aspiration pneumonia

My grandfather had dentures. He used to pop them in and out for the entertainment of my children. The first time I remember seeing his dentures, they were in a glass jar in the bathroom. My grandfather cleaned them after every meal and took them out when he went to bed. Little did he know his routine not only kept his mouth healthy, but also may have saved his life!

BY NOEL BRANDON KELSCH, RDHAP

My grandfather had dentures. He used to pop them in and out for the entertainment of my children. The first time I remember seeing his dentures, they were in a glass jar in the bathroom. My grandfather cleaned them after every meal and took them out when he went to bed. Little did he know his routine not only kept his mouth healthy, but also may have saved his life!

As health-care providers, we are all aware that poor oral health and poor dental hygiene are recognized as major risk factors in full-body health. Aspiration pneumonia has been linked to poor oral health with susceptible hosts and elderly clients.1,2,3,4 Are we sharing that information with our patients and their caregivers? Are we explaining why it is vital to clean the denture frequently and remove the denture at night?

-------------------------------------------------------

Other articles by Kelsch

-------------------------------------------------------

A study from the Nihon University School of Dentistry in Japan looked at the associations between oral health behaviors and the rate of pneumonia in communal living situations of those 85 years and older. The focus of the study was areas that could be modified.

The study was very comprehensive, using 524 randomly selected seniors with the average age being 87.8. They evaluated oral health status and oral hygiene behaviors, as well as gave medical assessments, including blood chemistry analysis. They followed up with each senior annually until the first hospitalization or death occurred from pneumonia. This long-term study followed the seniors for three years, and during the study, 48 pneumonia-associated events occurred. Of those 48 events, 20 participants died and 28 were in acute care at the hospital. Among the 453 denture wearers, 40.8%, or 186 wearers, wore their dentures while sleeping and were at higher risk for pneumonia than those who removed their dentures at night.5

The study also revealed some other interesting contributing factors. Both perceived swallowing difficulties and overnight denture wearing were independently associated with approximately 2.3-fold higher risk of the incidence of pneumonia, which was comparable with the high risk attributable to cognitive impairment, history of stroke, and respiratory disease! As if that weren't enough, the study also concluded that wearing a denture through the night increases:

• Tongue and denture plaque and microbial bioburden

• Oral inflammation

• Positive culture for candida albicans

• Levels of circulating interleukin-6 as compared to their counterparts5

So what do we need to share with patients and caregivers? We need to let them know that current science has revealed that wearing the denture during sleep is associated with:

• Oral inflammation

• Microbial burden

• Aspiration pneumonia

Cleaning the denture daily should be built into care plans for seniors, and all denture-wearing patients should remove them during sleep. These simple modifications could save lives. RDH

References

1. Yoneyama T, et al. Oral care reduces pneumonia in older patients in nursing homes. Journal of the American Geriatrics Society 50.3 (2002): 430-433.

2. Terpenning MS, et al. Aspiration pneumonia: dental and oral risk factors in an older veteran population. Journal of the American Geriatrics Society 49.5 (2001): 557-563.

3. Taylor GW, Loesche WJ, Terpenning MS. Impact of oral diseases on systemic health in the elderly: diabetes mellitus and aspiration pneumonia. Journal of Public Health Dentistry 60.4 (2000): 313-320.

4. Azarpazhooh A, Leake JL. Systematic review of the association between respiratory diseases and oral health. Journal of Periodontology 77.9 (2006): 1465-1482.

5. Iinuma T, Arai Y, Abe Y, Takayama M, Fukumoto M, Fukui Y, Iwase T, Takebayashi T, Hirose N, Gionhaku N, and Komiyama K. Denture wearing during sleep doubles the risk of pneumonia in the very elderly. J Dent Res 0022034514552493, first published on October 7, 2014 as doi:10.1177/0022034514552493.

Some tips to give your patients on denture care

• Remove and rinse your dentures after every meal.

• Clean the soft tissue in your mouth with an extra-soft toothbrush or a clean, damp washcloth.

• Thoroughly clean your dentures at least daily. Even if you use a product with effervescence, you will still have to brush the dentures. Use a soft toothbrush or denture brush and avoid very stiff brushes, baking soda, and abrasives, as they will wear the denture down over time. You can use dish soap, mild toothpaste with no whitening agent, or products designed for dentures.

• Before brushing the denture, lay a towel in the sink so if you drop the denture, it does not break.

• Most dentures need to remain moist to keep their shape. Put the dentures in water or a very mild denture soaking solution. Talk with your dentist about the mild solution you should be using for your specific case. Many dentures have metal in them and some solutions may be hard on the metal or resin.

• Always rinse the denture before putting it back in the mouth.


NOEL BRANDON KELSCH, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists' Association.

More in Infection Control