Brushing teeth may lower risk for hospital-acquired pneumonia

Key takeaways:

• Toothbrushing was also linked to fewer days on mechanical ventilation and lower ICU mortality rates.
• The findings demonstrate that toothbrushing is a cheap and effective infection prevention strategy.

Daily toothbrushing was linked to a significantly decreased risk for hospital-acquired pneumonia, or HAP, as well as lower rates of ICU mortality, according to a systematic review and meta-analysis published in JAMA Internal Medicine.

“I was surprised to see that toothbrushing was associated with lower mortality rates,” Michael Klompas, MD, MPH, an infectious disease physician in the department of medicine at Brigham and Women’s Hospital, told Healio. “It’s unusual to find a preventive strategy that lowers mortality rates. And to think that it’s something as simple and inexpensive as toothbrushing is remarkable.”

Klompas and Selina Ehrenzeller, MD, head of the division of infectious diseases and hospital epidemiology at the University of Basel in Switzerland, conducted a systematic review and meta-analysis to investigate associations between toothbrushing vs. oral care without toothbrushing and HAP, “the most common and morbid nosocomial infection” where “little consensus exists on how best to prevent it.”

“Toothbrushing may be more effective than antiseptics at reducing microbial burden, since mechanical scrubbing may better disrupt plaque and other biofilms compared with antiseptics,” they wrote.

The study included 15 trials with an effective sample size of 2,786 hospitalized patients. The researchers found that toothbrushing was linked to a significantly decreased risk for:

• HAP (RR = 0.67; 95% CI, 0.56-0.81); and
• ICU mortality (RR = 0.81; 95% CI, 0.69-0.95).

There was also a significant reduction in pneumonia incidence among patients on invasive mechanical ventilation whose teeth were brushed daily (RR = 0.68; 95% CI, 0.57-0.82) but not among those who were not on invasive mechanical ventilation.

Meanwhile, toothbrushing in the ICU was associated with:

• fewer days on mechanical ventilation (mean difference [MD] = –1.24; 95% CI, –2.42 to –0.06); and
• shorter ICU length of stay (MD = –1.78; 95% CI, –2.85 to –0.7).

The results were similar for brushing two, three and four times a day, according to the researchers.

“Our findings suggest that hospitals should develop policies and procedures to assure that all hospitalized patients get their teeth brushed at least twice a day,” Klompas said. “We hope that future studies will gather more data on the impact of toothbrushing in non-ICU patients.”

In a related editorial, Rupak Datta, MD, PhD, an assistant professor at Yale School of Medicine, wrote that the study represents “an exciting contribution to infection prevention and reinforces the notion that routine toothbrushing is an essential component of standard of care in ventilated patients.”

“As the literature on HAP continues to evolve, oral hygiene could assume an indispensable role akin to hand hygiene in the prevention and control of health care associated infections,” he wrote.

References:

• Datta R. JAMA Intern Med. 2023;doi:10.1001/jamainternmed.2023.6807.
• Ehrenzeller S, Klompas M. JAMA Intern Med. 2023;doi:10.1001/jamainternmed.2023.6638.
• Toothbrushing tied to lower rates of pneumonia among hospitalized patients. https://www.eurekalert.org/news-releases/1011253. Published Dec. 18, 2023. Accessed Dec. 18, 2023.