ORAL HEALTH IN NURSING HOMES: WHAT WE KNOW AND WHAT WE NEED TO KNOW

Impaired oral health: a required companion of bacterial aspiration pneumonia

Laryngotracheal aspiration has a widely-held reputation as a primary cause of lower respiratory infections, such as pneumonia, and is a major concern of care providers of the seriously ill orelderly frail patient. Laryngeal mechanical inefficiency resulting in aspiration into the lower respiratory tract, by itself, is not the cause of pneumonia. It is but one of several factors that must be present simultaneously for pneumonia to develop. Aspiration of oral and gastric contentsoccurs often in healthy people of all ages and without significant pulmonary consequences. Inthe seriously ill or elderly frail patient, higher concentrations of pathogens in the contents of theaspirate are the primary catalyst for pulmonary infection development if in an immunocompromised lower respiratory system. The oral cavity is a complex and ever changing eco-environment striving to maintain homogeneity among the numerous microbial communities inhabiting its surfaces. Poor maintenance of these surfaces to prevent infection can result inpathogenic changes to these microbial communities and, with subsequent proliferation, can altermicrobial communities in the tracheal and bronchial passages. Higher bacterial pathogen concentrations mixing with oral secretions, or with foods, when aspirated into an immunecompromised lower respiratory complex, may result in bacterial aspiration pneumonia development, or other respiratory or systemic diseases. A large volume of clinical evidence makes it clear that oral cleaning regimens, when used in caring for ill or frail patients in hospitals and long-term care facilities, drastically reduce the incidence of respiratory infection and death. The purpose of this narrative review is to examine oral health as a required causative companionin bacterial aspiration pneumonia development, and the effectiveness of oral infection control inthe prevention of this disease.

Oral and Mucosal Complaints among Institutionalized Care Seniors in Malopolska Voivodeship-The Utility of the Mirror Sliding Test in an Assessment of Dry Mouth

The purpose of this article was to evaluate reported oral and mucosal complaints among seniors residing in institutionalized 24-h care of the Municipal Center for Older and Dependent People (MHCOD) and the 3-month rehabilitation program of the Daily Medical Care House (DMCH). We evaluated the feasibility of using the dental mirror slidding test to assess dry mouth of seniors. Patients underwent a questionnaire, and clinical examination. The Visual Analogue Scale (VAS) was used to assess pain, Fox's questionnaire and Challacombe's scale with Clinical Oral Dryness Score to assess dryness of the mouth, dental mirror slidding test to assess buccal mucosal resistance. Dryness, mucosal burning, impaired taste, food intake are symptoms associated with seniors, and their frequency does not depend on the type of care. The incidence of mucosal burning (Mdn = 4.0, IQR = 4.75, p = 0.032) and difficulty in using dental prosthetics (Mdn = 3.0, IQR = 4.00, p = 0.010) increase with the length of stay at MHCOD. Seniors are at risk of side effects of polypharmacy, which cause dryness (p = 0.036), complaints of lack of saliva (p = 0.009) and taste disorders (p = 0.041. Seniors with higher levels of dry mouth are more likely to exhibit mucosal burning (p = 0.026) and difficulty in taking food (p = 0.037). The implementation of the dental mirror slidding test in the scope of the primary care of geriatric examination should be discussed.

Oral Health of Elderly People in Institutionalized Care and Three-Month Rehabilitation Programme in Southern Poland: A Case-Control Study

Demographic ageing is a global growing process and the quality of ageing is an important parameter in this process. The aim of the study was to analyse the distribution of remaining dentition in relation to oral hygiene indicators among elderly people remaining in institutional care and those who participated in a 3-month rehabilitation program, aimed at increasing time of independent functioning, in southern Poland. The patients underwent a questionnaire and clinical examination. An analysis of missing teeth was performed, plaque index, and gingival index were measured. Residents of the Municipal Health Centre for Older and Dependent People (n = 50) had a higher incidence of missing teeth in the maxilla (88.4%), mandible (77.6%), as well as in the maxilla and mandible combined (83%) than residents of the Daily Medical Care House (n = 30). The distribution of the remaining teeth, in both groups, corresponds to the outlets of the large salivary glands. The group of 53.8% of patients with dry mouth had PI scored 3. Residents with dry mouth were more likely to have plaque deposits and gingival inflammation. It is necessary to develop and implement an oral care program for patients with reduced saliva secretion, with a particular focus on dependents.