Sir, Dr H. Frenkel (BDJ 2009; 207: 4–5), and Dr A. Korada (BDJ 2009; 206: 396), among others, have described the 'terrible condition' of oral health among people living in care homes, and pointed out that oral hygiene is often insufficient among the residents. However, the consequences of neglected oral care have not been thoroughly disseminated among dental, medical and nursing professionals. Therefore, the hitherto published research evidence that indicates a strong relationship between insufficient oral hygiene and healthcare-associated pneumonia (nosocomial pneumonia) among nursing home residents and hospitalised elderly is briefly summarised below.

In a systematic review in 2006, it was concluded that there is strong evidence that improved oral hygiene and frequent professional oral care reduces the progression or occurrence of respiratory tract diseases among high-risk elderly living in nursing homes and intensive care units (relative risk reduction 34-83 %).1

In another, recent, systematic review, it was concluded that there is strong evidence that mechanical oral hygiene leads to about 9-11% absolute risk reduction for mortality from pneumonia, and to a clinically obvious preventive effect on healthcare-associated pneumonia among nursing home residents and hospitalised elderly, with about 7% absolute risk reduction.2

Translated to numbers needed to treat, approximately one out of ten cases of death from pneumonia among these individuals could be prevented by improving their oral hygiene.2 The oral hygiene measures studied were: weekly conducted professional oral hygiene, or tooth brushing after every meal, alone, or in combination with daily 1% povidone iodine scrubbing of pharynx.3,4,5 A plausible mechanism for the infection pathway in healthcare-associated pneumonia is silent aspiration of respiratory pathogens from the oral cavity and oropharynx into the lung.

In light of the available evidence, the importance of oral care cannot be overlooked. Individual oral care needs to be integrated in the care-chain of hospitalised or nursing home resident elderly. This is not only a matter of saving lives but can also lead to a considerable net gain in care costs; money which then can be used to save other lives.