Pneumonia occurring in residents of long‐term care facilities and nursing homes can
be termed 'nursing home‐acquired pneumonia' (NHAP). NHAP is the leading cause of mortality
among residents. NHAP may be caused by aspiration of oropharyngeal flora into the
lung, and by failure of the individual's defence mechanisms to eliminate the aspirated
bacteria. Oral care measures to remove or disrupt oral plaque might be effective in
reducing the risk of NHAP. To assess effects of oral care measures for preventing
nursing home‐acquired pneumonia in residents of nursing homes and other long‐term
care facilities. Cochrane Oral Health’s Information Specialist searched the following
databases: Cochrane Oral Health’s Trials Register (to 15 November 2017), the Cochrane
Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue
10), MEDLINE Ovid (1946 to 15 November 2017), and Embase Ovid (1980 to 15 November
2017) and Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1937 to
15 November 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov)
and the World Health Organization International Clinical Trials Registry Platform
were searched for ongoing trials. No restrictions were placed on the language or date
of publication when searching the electronic databases. We also searched the Chinese
Biomedical Literature Database, the China National Knowledge Infrastructure, and the
Sciencepaper Online to 20 November 2017. We included randomised controlled trials
(RCTs) that evaluated the effects of oral care measures (brushing, swabbing, denture
cleaning mouthrinse, or combination) in residents of any age in nursing homes and
other long‐term care facilities. At least two review authors independently assessed
search results, extracted data, and assessed risk of bias in the included studies.
We contacted study authors for additional information. We pooled data from studies
with similar interventions and outcomes. We reported risk ratio (RR) for dichotomous
outcomes, mean difference (MD) for continuous outcomes, and hazard ratio (HR) for
time‐to‐event outcomes, using random‐effects models. We included four RCTs (3905 participants),
all of which were at high risk of bias. The studies all evaluated one comparison:
professional oral care versus usual oral care. We did not pool the results from one
study (N = 834 participants), which was stopped at interim analysis due to lack of
a clear difference between groups. We were unable to determine whether professional
oral care resulted in a lower incidence rate of NHAP compared with usual oral care
over an 18‐month period (hazard ratio 0.65, 95% CI 0.29 to 1.46; one study, 2513 participants
analysed; low‐quality evidence). We were also unable to determine whether professional
oral care resulted in a lower number of first episodes of pneumonia compared with
usual care over a 24‐month period (RR 0.61, 95% CI 0.37 to 1.01; one study, 366 participants
analysed; low‐quality evidence). There was low‐quality evidence from two studies that
professional oral care may reduce the risk of pneumonia‐associated mortality compared
with usual oral care at 24‐month follow‐up (RR 0.41, 95% CI 0.24 to 0.72, 507 participants
analysed). We were uncertain whether or not professional oral care may reduce all‐cause
mortality compared to usual care, when measured at 24‐month follow‐up (RR 0.55, 95%
CI 0.27 to 1.15; one study, 141 participants analysed; very low‐quality evidence).
Only one study (834 participants randomised) measured adverse effects of the interventions.
The study identified no serious events and 64 non‐serious events, the most common
of which were oral cavity disturbances (not defined) and dental staining. No studies
evaluated oral care versus no oral care. Although low‐quality evidence suggests that
professional oral care could reduce mortality due to pneumonia in nursing home residents
when compared to usual care, this finding must be considered with caution. Evidence
for other outcomes is inconclusive. We found no high‐quality evidence to determine
which oral care measures are most effective for reducing nursing home‐acquired pneumonia.
Further trials are needed to draw reliable conclusions. Mouth care for preventing
pneumonia in nursing homes Review question Does oral (mouth) care cut down pneumonia
(a lung infection) in nursing homes? We aimed to summarise the findings from studies
known as 'randomised controlled trials' in order to identify whether mouth care helped
prevent pneumonia in elderly people living in nursing homes or other care facilities,
and which approach to mouth care was best. Background Pneumonia is common among elderly
people living in nursing homes. Nursing home‐acquired pneumonia (NHAP) is a bacterial
infection of the lung that occurs in residents of long‐term care facilities and nursing
homes. Poor oral hygiene is considered to contribute to the likelihood of contracting
an infection. Professional mouth care is a combination of brushing teeth and mucosa,
cleaning dentures, using mouthrinse, and check‐up visits to a dentist, while usual
mouth care is generally less intensive, and is self‐administered, or provided by nursing
home staff without special training in oral hygiene. Study characteristics This review
was carried out through Cochrane Oral Health. We searched scientific databases for
relevant studies, up to 15 November 2017. We included four studies, with a total of
3905 participants randomly assigned to treatment or usual care. Participants were
long‐term‐care elderly residents in nursing homes who did not have pneumonia at the
beginning of the studies. Some of the participants had dementia or systemic diseases.
All studies focused on the comparison between 'professional' mouth care and 'usual'
mouth care. None of the studies evaluated oral care versus no oral care. Key results
We identified four studies, all of which compared professional mouth care to usual
mouth care in nursing home residents. From the limited evidence, we could not tell
whether professional oral mouth care was better or worse than usual mouth care for
preventing pneumonia. The evidence for death from any cause was inconclusive, but
the studies did suggest that professional mouth care may reduce the number of deaths
caused by pneumonia, compared to usual mouth care, when measured after 24 months.
Only one study measured negative effects of the interventions, and reported that there
were no serious events. The most common non‐serious events reported were damage to
the mouth and tooth staining. Quality of the evidence The quality of the evidence
is low or very low, because of the small number of studies and problems with their
design. Therefore, we cannot rely on the findings, and further research is required.