Summary Review/Periodontology
Evidence-Based Dentistry (2007) 8, 116. doi:10.1038/sj.ebd.6400532
Oral health and respiratory diseases
Is there an association between oral health and pneumonia or other respiratory diseases?
Address for correspondence Dr Amir Azarpazhooh, Department of Community Dentistry, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada. E-mail: amir.azarpazhooh@utoronto.ca
Ian Needleman1 and Nicholas Hirsch2
- 1International Centre for Evidence-Based Oral Health, Unit of Periodontology, University College London Eastman Dental Institute, London, UK
- 2Neuromedical Intensive Care Unit, National Hospital for Neurology and Neurosurgery, University College London Hospital NHS Foundation Trust, London, UK
Azarpazhooh A, Leake JL. Systematic review of the association between respiratory diseases and oral health. J Periodontol 2006; 77:1465–482.
Abstract
Data sources
Relevant studies were sourced using Ovid Medline (In-Process and Other Non-Indexed Citations, Daily Update and OLDMedline); Cumulative Index to Nursing and Allied Health Literature; Evidence Based Medicine of Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects; Embase; Health and Psychosocial Instruments; HealthSTAR; International Pharmaceutical Abstracts; PubMed; and Google Scholar.
Study Selection
Randomised controlled clinical trials and longitudinal, cohort, case–control and epidemiological studies were selected. Searches were limited to English language and human studies.
Data extraction and synthesis
Data were extracted independently, evidence tables constructed and a qualitative summary made of the data.
Results
Nineteen studies met the inclusion criteria. In five studies, the presence of cariogenic and periodontal pathogens, dental decay, and poor oral hygiene were identified as potential risk factors for pneumonia. A weak association between periodontal disease and chronic obstructive pulmonary disease (COPD) was identified in four poor to fair studies. Ten studies provided evidence that interventions aiming to improve oral health reduced the progression or occurrence of pneumonia.
Conclusions
First, there is fair evidence (II-2, grade B recommendation) of an association of pneumonia with oral health [odds ratio (OR), 1.2–9.6 depending on oral health indicators]. Second, there is poor evidence of a weak association (OR<2.0) between COPD and oral health (II-2/3, grade C recommendation). Third, there is good evidence (I, grade A recommendation) that improved oral hygiene and frequent professional oral healthcare reduces the progression or occurrence of respiratory diseases in high-risk elderly adults living in nursing homes and especially those in intensive care units (number needed to treat, 2–16; relative risk reduction, 34–83%).
