How Daily Tooth Brushing Lowers the Risk of Nosocomial Pneumonia

Brushing your teeth while receiving hospital treatment can significantly decrease your risk of developing pneumonia.

Despite its benefits, many patients in hospitals neglect to brush their teeth. Reasons may vary, including forgetting a toothbrush, lack of motivation, or physical limitations. Additionally, healthcare providers often fail to prioritize routine oral hygiene for patients.

The largest randomized controlled trial in this area revealed that patients who received toothbrushes, toothpaste, and educational materials on dental care were 60% less likely to acquire pneumonia during their hospital stay, according to Brett Mitchell from Avondale University, Australia.

“This underscores the necessity of discussing pneumonia risks and the critical role of oral care and tooth brushing during hospitalization,” he states.

Pneumonia, especially ventilator-associated pneumonia, often arises due to medical devices disrupting normal respiratory functions. However, many hospitalized patients not on ventilators also develop pneumonia 48 hours post-admission. Ongoing research aims to uncover why this occurs and how to prevent it. Nosocomial pneumonia is notably linked to increased length of hospital stays, higher costs, and elevated mortality rates, as mentioned in this study.

“This is a crucial inquiry,” says Michael Klompas from Harvard University, who was not affiliated with the study. “Nosocomial pneumonia is among the most prevalent and lethal hospital-acquired infections, yet we lack concrete data on effective preventative strategies.”

Mitchell hypothesized a connection between the disease and oral bacteria. The oral microbiome can influence respiratory health as bacteria-laden droplets may be inhaled into the lungs. When hospitalized, a patient’s oral microbiome can shift, highlighting a pressing need for intervention, he explains.

Consequently, he and his team initiated a year-long randomized controlled trial involving 8,870 patients across three Australian hospitals to assess the impact of oral care on pneumonia risk. Mitchell presented the findings from this segment of the Nosocomial Pneumonia Prevention (‘HAPPEN’) study at the European Society for Clinical Microbiology and Infectious Diseases (ESCMID Global) conference in Munich, Germany.

In the study, each hospital divided participants into three groups, with no interventions in the first three months. After this period, one group received toothbrushes and toothpaste featuring motivational messages like “Brushing your teeth helps prevent pneumonia” and “Blow away pneumonia!” These brushes were designed with special handles for ease of use. Patients were also given QR codes linking to educational resources on the HAPPEN website.

After six months, a second group received brushes, followed by the third group after nine months, allowing all participants to practice tooth brushing for the study’s last three months.

To support medical staff, the research team provided oral care training for ward nurses and linked professional advice on their website. They encouraged nurses to remind patients about oral care and assist those who struggled with brushing.

During the non-intervention phase, only 15.9% of patients brushed their teeth daily. However, during the intervention phase, 61.5% of patients engaged in daily oral care, averaging 1.5 brushes per day. Web analytics showed that both patients and nurses frequently accessed information on the HAPPEN portal during this period, noted Mitchell.

Simultaneously, the incidence of hospital-acquired pneumonia unrelated to ventilators saw a significant decline, dropping from 1 case per 100 hospital days in the control group to 0.41 cases in the intervention group.

“This study is groundbreaking,” Klompas remarks, emphasizing the substantial sample size and randomized methodology. “Brushing your teeth while hospitalized not only promotes oral health but can also save lives.”

Piry Sipila from the University of Helsinki appreciates the profound risk reduction achieved through such simple interventions. “Patients were essentially provided with a toothbrush, toothpaste, and basic advice,” he observes. Nonetheless, outcomes may differ based on hospitalization reasons and patients’ usual oral hygiene practices.