Limeback H
Faculty of Dentistry, University of Toronto, Canada.
Ann Periodontol. 1998 Jul;3(1):262-75. doi: 10.1902/annals.1998.3.1.262.
Systemic infection in the elderly patient living in a chronic care setting presents a significant burden to the health care system. The extent to which oral organisms cause systemic infections through hematogenous dissemination in the institutionalized elderly is still unknown. A more likely and common route of systemic infection by oral microorganisms is through aspiration of oropharyngeal fluids containing oral pathogenic microorganisms, which colonize the lower respiratory tract and cause pneumonia. Respiratory pathogens emerge in the dental plaque of elderly patients with very poor oral hygiene and severe periodontal disease. In the chronic care setting, aspiration of oropharyngeal fluids contaminated with these bacteria occurs in patients with diminished host defenses, resulting in bacterial pneumonia. This is also a problem in intensive care units in the hospital setting. In one study, pre-rinsing with a 0.12% chlorhexidine gluconate mouthwash significantly lowered the mortality rate from postsurgical pneumonia in patients undergoing open heart surgery. Selective digestive decontamination, a technique involving the topical application of antimicrobials to reduce the risk of colonization of the respiratory tract, has been used to reduce the incidence of nosocomial pneumonia in the acute care setting of hospitals. This technique has not been employed in the nursing home setting. Whether improving oral hygiene would also lower the risk in either of these settings has not been studied. A number of obstacles must be overcome in designing studies to investigate the relationship between oral infections and lung infections in the institutionalized elderly. Ethical issues must be addressed, and full collaboration of the medical team is required. Future studies should establish whether reducing the risk for pneumonia in the institutionalized elderly is possible through improved oral health.
居住在长期护理机构中的老年患者发生全身感染给医疗保健系统带来了沉重负担。在机构养老的老年人中，口腔微生物通过血行播散引起全身感染的程度尚不清楚。口腔微生物引起全身感染更可能且常见的途径是吸入含有口腔致病微生物的口咽分泌物，这些微生物定植在下呼吸道并导致肺炎。呼吸道病原体出现在口腔卫生极差和患有严重牙周病的老年患者的牙菌斑中。在长期护理机构中，宿主防御能力减弱的患者会吸入被这些细菌污染的口咽分泌物，从而导致细菌性肺炎。这在医院环境的重症监护病房中也是一个问题。在一项研究中，用0.12%的葡萄糖酸氯己定漱口水预冲洗可显著降低接受心脏直视手术患者术后肺炎的死亡率。选择性消化道去污是一种通过局部应用抗菌药物来降低呼吸道定植风险的技术，已被用于降低医院急性护理环境中医院获得性肺炎的发生率。这项技术尚未在养老院环境中应用。改善口腔卫生是否也能降低这两种环境中的风险尚未得到研究。在设计研究以调查机构养老老年人口腔感染与肺部感染之间的关系时，必须克服许多障碍。必须解决伦理问题，并且需要医疗团队的充分协作。未来的研究应确定通过改善口腔健康是否有可能降低机构养老老年人患肺炎的风险。
