Scannapieco Frank A
Department of Oral Biology, School of Dental Medicine, University at Buffalo, State University of New York, 109 Foster Hall, Buffalo, N.Y. 14214.
J Am Dent Assoc. 2006 Oct;137 Suppl:21S-25S. doi: 10.14219/jada.archive.2006.0400.
Considerable evidence exists to support a relationship between poor oral health, the oral microflora and bacterial pneumonia, especially ventilator-associated pneumonia in institutionalized patients. Teeth or dentures have nonshedding surfaces on which oral biofilms (that is, dental plaque) form that are susceptible to colonization by respiratory pathogens. Subsequent aspiration of respiratory pathogens shed from oral biofilms into the lower airway increases the risk of developing a lung infection. In addition, patients may aspirate inflammatory products from inflamed periodontal tissues into the lower airway, contributing to lung insult.
The author reviewed laboratory studies, clinical trials and review articles.
A number of studies have shown that the mouth can be colonized by respiratory pathogens and serve as a reservoir for these organisms. Other studies have demonstrated that oral interventions aimed at controlling or reducing oral biofilms can reduce the risk of pneumonia in high-risk populations. Taken together, the evidence is substantial that improved oral hygiene may prevent pneumonia in vulnerable patients.
Institution of rigorous oral hygiene regimens for hospitalized patients and long-term-care residents may reduce the risk of developing pneumonia.
有大量证据支持口腔健康不佳、口腔微生物群与细菌性肺炎之间存在关联，尤其是在机构化照护患者中的呼吸机相关性肺炎。牙齿或假牙具有不易脱落的表面，口腔生物膜（即牙菌斑）会在这些表面形成，呼吸道病原体易在其上定植。随后，从口腔生物膜脱落的呼吸道病原体被误吸入下呼吸道会增加发生肺部感染的风险。此外，患者可能会将来自发炎牙周组织的炎性产物误吸入下呼吸道，从而加重肺部损伤。
作者综述了实验室研究、临床试验和综述文章。
多项研究表明，呼吸道病原体可在口腔定植，并成为这些病原体的储存库。其他研究表明，旨在控制或减少口腔生物膜的口腔干预措施可降低高危人群患肺炎的风险。综合来看，有充分证据表明改善口腔卫生可能预防易感患者发生肺炎。
为住院患者和长期护理机构居民制定严格的口腔卫生方案可能会降低患肺炎的风险。
