Pneumonia incidence and oral health management by dental hygienists in long-term care facilities: A 1-year prospective multicentre cohort study

Abstract

Objective: To investigate the association between oral health management (OHM) by dental hygienists and the occurrence of pneumonia, and determine the effectiveness of OHM in pneumonia prevention.

Background: In long-term care facilities in Japan, the need for professional OHM is increasing with an increase in the number of severely debilitated residents.

Materials and methods: A 1-year prospective multicentre cohort study was conducted using data from 504 residents (63 men; mean age: 87.4 ± 7.8 years) in Japanese long-term care facilities. Basic information, medical history, willingness to engage in oral hygiene behaviour, need for OHM and oral conditions were investigated at baseline. In addition, information on the occurrence of pneumonia was collected using a follow-up survey after one year. A Poisson regression analysis with robust standard errors was conducted, with pneumonia as the dependent variable, and factors associated with OHM and pneumonia occurrence as explanatory variables.

Results: Overall, 349 (69.2%) residents required OHM by dental hygienists during that year of follow-up. Of those, 238 (68.2%) were provided with OHM, and 18 (7.5%) developed pneumonia. Among the 111 patients (31.8%) who were not provided with OHM, 21 (18.9%) developed pneumonia. The OHM group had lower pneumonia rates than the non-OHM group (prevalence rate ratio: 0.374; 95% CI: 0.210-0.665).

Conclusion: Oral health management by dental hygienists was associated with a lower incidence of pneumonia among residents of long-term care facilities, underlining the importance of professional OHM for such individuals. It is recommended that OHM be practised routinely in long-term care facilities.

Keywords: dental hygienists; long-term care; oral health; pneumonia.

FIGURE 1

Flow chart of study participants. A baseline survey of 889 residents of long‐term care insurance facilities was conducted. For follow‐up, 525 (59.0%) residents gave consent to participate. Of these, 21 (2.3%) participants receiving parenteral feeding at the time of the baseline survey were excluded. The remaining 504 (56.7%) participants were divided into groups based on their need for oral health management (OHM) by a dental hygienist. Of the 349 (69.2%) residents who needed OHM by a dental hygienist, 238 (68.2%) were provided the service, and 111(31.8%) were not provided the service. Among the 238 residents who were provided OHM by a dental hygienist, 18 (7.5%) residents had pneumonia, and 220 (92.5%) residents did not during that year. Among the 111 residents who did not receive OHM by a dental hygienist, 21 (18.9%) residents had pneumonia, and 90 (81.1%) residents did not during that year