The oral cavity is an environment that consists of numerous species of microorganisms (both bacterial and fungal) together with their biofilms and cytokines (chemicals). Most of these organisms are beneficial and are thus termed normal flora. In cases of poor hygiene, the oral cavity is invaded by disease causing organisms which increase the risk of aspirating in bedridden individuals. In this article we discuss the relationship between oral care and aspiration pneumonia.
The risk of suffering from aspiration pneumonia is significantly increased in the presence of oral cavity diseases such as dental caries and periodontal disease. This is mainly because of the existence of pockets of infections where bacterial organisms are trapped. Other conditions that are also known to increase this risk include inability to feed, the use of nasogastric tube feeding, swallowing difficulties and poor motor function.
It has been shown through research that close to 15% of adults have swallowing difficulties. This figure appears to increase as we advance in age due to what are believed to be changes taking place in the physiology and anatomy of the oropharynx. At the age of 80 years, it appears that almost half of the people have varying degrees of swallowing challenges. Other factors that may contribute to the problem include stroke, cerebral palsy and dementia among others.
One of the interventions that have been shown to lower the risk of aspirating is a change in feeding posture. The position that is chosen should be less than 90 degrees from the horizontal plane. There is a need for the caregiver and the patient to be taken through maneuvers that can be adopted to reduce this risk as much as possible. Several sessions of training are typically needed.
The numerous medications that are prescribed for this group of patients may in some cases inhibit the swallowing reflex. For this reason all drugs need to be carefully considered with regard to their effect on swallowing. Other interventions that may be undertaken include dietary modification, administration of medications to reduce gastric acid secretion (proton pump inhibitors) and to minimize the secretions by giving drugs such as angiotensin converting enzymes.
Most of the elderly patients undergoing long term care also suffer a suppression in their oral functions. This is mainly due to their depressed level of consciousness. The cavity is initially abnormally dry resulting in reflex production of mucosal secretions and saliva. The secretions get mixed up with solid residuals that have not been cleared and form a sticky paste which adheres on mucosal surfaces and the teeth.
With self-cleaning mechanisms of the oral cavity suppressed, there is a need to artificially remove this sticky paste from the cavity. If this is not done, the area will be colonized by harmful bacteria that can easily cause upper respiratory tract infections and aspiration pneumonia. Gram negative bacteria are the most commonly isolated organisms in such settings. Even if overt aspiration does not occur, silent aspiration of microorganisms may cause pneumonia.
Maintaining good oral health will not only lower the risk of aspiration but that of other local and systemic complications as well. Such may include abscess formation and infective endocarditis. It is important to bear in mind that the elderly are at an increased risk of poor hygiene and aspiration due to multiple factors. Preventing aspiration is done through eliminating as many of the risk factors as possible.
The risk of suffering from aspiration pneumonia is significantly increased in the presence of oral cavity diseases such as dental caries and periodontal disease. This is mainly because of the existence of pockets of infections where bacterial organisms are trapped. Other conditions that are also known to increase this risk include inability to feed, the use of nasogastric tube feeding, swallowing difficulties and poor motor function.
It has been shown through research that close to 15% of adults have swallowing difficulties. This figure appears to increase as we advance in age due to what are believed to be changes taking place in the physiology and anatomy of the oropharynx. At the age of 80 years, it appears that almost half of the people have varying degrees of swallowing challenges. Other factors that may contribute to the problem include stroke, cerebral palsy and dementia among others.
One of the interventions that have been shown to lower the risk of aspirating is a change in feeding posture. The position that is chosen should be less than 90 degrees from the horizontal plane. There is a need for the caregiver and the patient to be taken through maneuvers that can be adopted to reduce this risk as much as possible. Several sessions of training are typically needed.
The numerous medications that are prescribed for this group of patients may in some cases inhibit the swallowing reflex. For this reason all drugs need to be carefully considered with regard to their effect on swallowing. Other interventions that may be undertaken include dietary modification, administration of medications to reduce gastric acid secretion (proton pump inhibitors) and to minimize the secretions by giving drugs such as angiotensin converting enzymes.
Most of the elderly patients undergoing long term care also suffer a suppression in their oral functions. This is mainly due to their depressed level of consciousness. The cavity is initially abnormally dry resulting in reflex production of mucosal secretions and saliva. The secretions get mixed up with solid residuals that have not been cleared and form a sticky paste which adheres on mucosal surfaces and the teeth.
With self-cleaning mechanisms of the oral cavity suppressed, there is a need to artificially remove this sticky paste from the cavity. If this is not done, the area will be colonized by harmful bacteria that can easily cause upper respiratory tract infections and aspiration pneumonia. Gram negative bacteria are the most commonly isolated organisms in such settings. Even if overt aspiration does not occur, silent aspiration of microorganisms may cause pneumonia.
Maintaining good oral health will not only lower the risk of aspiration but that of other local and systemic complications as well. Such may include abscess formation and infective endocarditis. It is important to bear in mind that the elderly are at an increased risk of poor hygiene and aspiration due to multiple factors. Preventing aspiration is done through eliminating as many of the risk factors as possible.
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