Weekly professional dental cleaning by a dental hygienist has been shown to reduce or eliminate the number of certain bacterial species from the oral cavity (e.g., streptococci, staphylococci, candida, pseudomonas, and bacteroides) in older adult residents of long-term care facilities. Samples from bronchoalveolar lavages from those patients hospitalized with pneumonia have contained samples of microorganisms contained in dental plaque. Some useful recommendations for dental practitioners who have patients in long-term care facilities follow: ● Inform patients and families about research suggesting that brushing the teeth helps reduce the risk of pneumonia for residents in nursing homes. ● Make sure the patient and family know the importance of maintaining recall appointments for professional cleanings and exams. ● Suggest special oral hygiene tools as appropriate. ● Create a daily oral hygiene plan for the patient that can be shared with the family and facility nursing staff. ● Provide in-service education for nursing-home nursing staff regarding the importance of keeping the resident’s mouth clean and the appropriate tools and techniques. Michalska & Lewkowicz, 2017). However, the data are conflicting. A study conducted on behalf of the American Heart Association (AHA) demonstrated no association between treatment of periodontal disease and decreased cardiovascular risk (Lockhart, et al., 2012). The AHA study included more than 500 peer-reviewed publications from 1950 through July 2011 addressing associations between periodontal disease and vascular disease. Although the study found that periodontal disease is independently associated with atherosclerotic vascular disease, it stressed that most studies have been observational in nature and thus do not confirm that periodontal disease is a causative agent of atherosclerotic vascular disease. Studies concerning a possible relationship between periodontal disease and cardiovascular disease continue (American Academy of Periodontology, n.d.; Glick, 2019). The following are recommendations for dental practitioners who have patients with a risk or history of stroke: ● Inform patients of the findings of the most current research examining vascular disease and periodontal disease. ● Encourage patients to maintain excellent oral hygiene. ● Provide oral hygiene instruction. ● Encourage patients to keep recall appointments for professional cleanings and examinations; they may need to schedule more frequent recall appointments. ● For patients who have suffered a stroke, suggest brushing and flossing aids. (See the section on osteoarthritis for a list.) those without diabetes (Agarwal & Baid, 2017; Santonocito, et al., 2022). There is a significant correlation between the prevalence, severity, or progression of periodontal disease and diabetes (Rohani, 2019). (This has already been addressed above.) The association is so well established that periodontal disease is the sixth most common complication of diabetes (Sakamoto & Bando, 2021; Karande, Khandeparkar, & Vergeese, 2017; Naiff, Carneiro, & do Carmo Guimarães, 2018). Achieving good periodontal outcomes in patients with diabetes requires both treating periodontal disease and addressing the hyperglycemia associated with diabetes (Vesna, 2018). Why does diabetes increase the risk of periodontal disease? Many authors have described the mechanisms that underlie
hygiene on respiratory disease in older adults found that nearly one in ten deaths from pneumonia may be prevented in older adults who live in long-term care facilities by simply providing better oral hygiene (Coker, et al., 2017; Müller, 2015). A similar effect was found among independent community-dwelling older adults; oral hygiene had a significant preventive effect against pneumonia and reduced the rates of mortality associated with it (Teramoto, 2020; Pusins, Ferguson, & Persaud, 2019). The consistent use of oral care management for patients with natural teeth and the routine cleansing of complete and/or partial dentures decreases the incidence of aspiration pneumonia among nursing home residents (Pusins, et al., 2019). Minimizing the plaque and associated bacterial burden through consistent oral hygiene practices will decrease the net amount of microbial species that can be aspirated into the lungs and will reduce but not eliminate the potential for the development of aspiration pneumonia by the elder residents. This would include mechanical cleansing of the lingual surface of the tongue and the mucosal surfaces beneath partial or complete dentures (Pusins, et al., 2019). Stroke There has been some contention among the researchers regarding the association between poor oral health, specifically periodontal disease, and ischemic stroke. Stroke is one of the most common and costly health conditions in older adults in the United States. In 2017, stroke was the fourth leading cause of death among adults age 65 and older (CDC, 2019a). Each year in the United States, approximately 795,000 people experience a stroke, with about 610,000 of these as their first stroke. Approximately 75% of these strokes occur in patients over 65 years of age, with the risk of having a stroke doubling each year after the age of 55 (CDC, 2020; Internet Stroke Center, 2020). The association between periodontal disease and the occurrence of a stroke relates to the role of pathogenic periodontal bacteria such as Porphyromonas gingivalis, Tannerella forsythia , and Treponema denticola in the development of atherosclerotic plaque, which can narrow the carotid arteries and cause a stroke (Fagundes, et al., 2019; Kulinska- Michalska & Lewkowicz, 2017). These plaques can narrow and occlude the blood flow through a blood vessel or can detach from a distant site and travel and occlude another blood vessel, with either scenario leading to an ischemic stroke. Systematic review and meta-analysis have suggested an increased risk of an ischemic stroke among patients with periodontal disease (Fagundes et al., 2019). The results of four cohort studies and seven case-controlled studies with study group populations that ranged from 95 to 29,584 individuals confirmed that periodontitis is an independent risk factor for the occurrence of a stroke (Kulinska- Diabetes Type 2 diabetes is a common chronic condition among older adults. Between 2013 and 2014, 23% of men and 19% of women over the age of 65 reported having diabetes. Diabetes is the seventh leading cause of death in non- Hispanic White adults age 65 and older and the fourth leading cause of death in non-Hispanic Blacks and Hispanics (Federal Interagency Forum on Aging-Related Statistics, 2016). Research suggests a bidirectional association between periodontal disease and diabetes, meaning that people with diabetes are more likely to develop periodontal disease and people with periodontal disease are more likely to develop diabetes or complications related to diabetes. The risk of periodontal disease has been shown to be two to three times greater in those with diabetes compared to
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