Oral care measures for preventing nursing home-acquired pneumonia

Oral health of nursing home residents in Flanders, Belgium, and its associated factors

Oral health in care-dependent older adults is often compromised due to care dependency associated with deteriorating general health. This cross-sectional study assessed the oral health of 458 nursing home residents in Flanders, with a mean age of 82.7 years (70.3% female), using the optimised Oral Health Section of the interRAI Suite of Instruments and validated dental indices. Among residents with natural teeth (53.9%), poor oral hygiene (75.7%), poor tooth condition (56.6%), and poor gum condition (49.9%) were common. High dental plaque levels yielded a mean Oral Hygiene Index of 4.5, and 44.0% of participants had untreated caries with pulp involvement. A mean Modified Gingival Index of 1.8 indicated mild inflammation of the entire gingiva. Denture hygiene was inadequate in 68.5% of cases. Self-reported issues included dry mouth (32.8%) and chewing difficulties (23.4%). The higher correlation coefficients were observed between oral hygiene and gum condition (r = 0.324, p < 0.0001) and between chewing difficulty and pain (r = 0.247, p < 0.0001). Bivariate analyses showed cognitive and functional impairments were strongly linked to poor oral hygiene and gingival health. These findings highlighted the persistent need to improve oral health care in nursing home residents, particularly among those with cognitive decline or reduced self-care abilities.Trial registration: ClinicalTrials.gov NCT06536322- Retrospectively registered July 23rd, 2024.

A Crossover Trial of a Novel Toothbrushing Method for Prevention of Aspiration Pneumonia: Toothpaste With Povidone-Iodine and Moisturizing Gel Mixture

INTRODUCTION

Toothbrushing, during which dental plaque is brushed off into the oral cavity, can increase the risk of aspiration pneumonia in older adults and intubated patients.

METHODS

This study examined brushing methods to prevent the spread of bacteria in the oral cavity. Six participants who required assistance with brushing received toothbrushing from a dental hygienist. Toothbrushing was performed using a toothbrush soaked in water (Water group), gel (Gel group), povidone-iodine solution (PV-I group), or a mixture of a moisturizing gel and povidone-iodine gel (PV-I+Gel group). The number of bacteria in the saliva before and after brushing was measured using a delayed real-time polymerase chain reaction, which can quantify the number of viable bacteria.

RESULTS

In the Water group, salivary bacterial counts increased significantly after brushing. The bacterial counts in the Gel and PV-I groups increased slightly after brushing; however, the increase was less than that observed in the Water group. In the PV-I+Gel group, the number of bacteria in the saliva was significantly reduced after brushing.

CONCLUSIONS

In patients at risk for aspiration pneumonia, toothbrushing should be performed with a mixture of PV-I and a moisturizing gel. This method is a novel approach that reduces the risk of aspiration pneumonia in intubated patients and older adults requiring care, and its clinical application is expected in the future.

Oral hygiene self-care: Concept analysis for the development of a new nursing diagnosis

OBJECTIVE

This study aims to analyze the concept of oral hygiene self-care and develop a new problem-focused nursing diagnosis (ND) based on the NANDA-I terminology.

METHOD

A concept analysis was performed based on the Walker and Avant framework, including a scoping review phase according to the Joanna Briggs Institute guidelines. Searches were performed in PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Virtual Health Library, and specific gray literature databases. The development of the diagnostic structure followed the NANDA-I guidelines with a focus on Orem's self-care theory.

RESULTS

Including 51 studies, the analysis facilitated the formulation of attributes, antecedents, and consequences of oral hygiene self-care. The ND "Oral hygiene self-care deficit" was created and included 17 defining characteristics, 9 related factors, 5 associated conditions, and 5 high-risk populations. Two cases were constructed to illustrate the use of key terms.

CONCLUSIONS

The conceptual analysis provided insight into the concept of oral hygiene self-care and supported the structure of a new ND.

IMPLICATIONS FOR NURSING PRACTICE

This study contributes to the implementation of the nursing process by focusing on the identification of individuals with oral hygiene self-care deficit. It will facilitate the promotion of oral health, thereby impacting the individual's quality of life. In addition, it will aid in the development of public policy for the prevention of oral diseases.

Factors affecting the number of bacteria in saliva and oral care methods for the recovery of bacteria in contaminated saliva after brushing: a randomized controlled trial

BACKGROUND

Oral care is important in preventing aspiration pneumonia in older adults. However, it is not clear what kind of oral care can reduce the number of bacteria in saliva. The purposes of this study are to clarify whether there is a relationship between plaque amounts and salivary bacterial counts, and how bacteria dispersed into the oral cavity by brushing can be reduced.

METHODS

First, saliva samples were collected from 10 healthy adult volunteers after 30 h of unbrushing and after thorough brushing, and the total bacterial count was determined by real-time PCR. Next, 40 older adults attending an outpatient dental clinic were randomly assigned into two groups: a wiping group (20 patients) and a mouthwashing group (20 patients). Saliva was collected before and after brushing, and after wiping in the wiping group and after mouthwashing in the mouthwashing group, and the total bacterial count was quantified by real-time PCR.

RESULTS

In a study of volunteers, there was no association between plaque amounts and salivary bacterial counts. In a study of older adult patients, salivary bacterial counts were significantly higher in patients with higher oral hygiene index and fewer remaining teeth. Brushing increased salivary bacterial counts. Wiping did not significantly reduce the number of bacteria, while mouthwash returned the increased number of bacteria after brushing to the pre-brushing level.

CONCLUSIONS

There is no direct relationship between the amount of plaque and the number of bacteria in saliva. Brushing disperses bacteria into the oral cavity, resulting in a marked increase in the number of bacteria in saliva. Wiping does not collect the dispersed bacteria, and it seems essential to rinse the mouth after brushing.

TRIAL REGISTRATION

UMIN000045854.