Research | Published:

Evidence summary: the relationship between oral health and pulmonary disease

BDJ volume 222, pages 527533 (07 April 2017) | Download Citation

Abstract

Introduction This paper is the second of four reviews exploring the relationships between oral health and general medical conditions, in order to support teams within Public Health England, health practitioners and policymakers.

Aim This review aimed to explore the most contemporary evidence on whether poor oral health and pulmonary disease occurs in the same individuals or populations, to outline the nature of the relationship between these two health outcomes, and discuss the implication of any findings for health services and future research.

Methods The work was undertaken by a group comprising consultant clinicians from medicine and dentistry, trainees, public health, and academics. The methodology involved a streamlined rapid review process and synthesis of the data.

Results The results identified a number of systematic reviews of medium to high quality which provide evidence that oral health and oral hygiene habits have an impact on incidence and outcomes of lung diseases, such as pneumonia and chronic obstructive pulmonary disease in people living in the community and in long-term care facilities. The findings are discussed in relation to the implications for service and future research.

Conclusion The cumulative evidence of this review suggests an association between oral and pulmonary disease, specifically COPD and pneumonia, and incidence of the latter can be reduced by oral hygiene measures such as chlorhexidine and povidone iodine in all patients, while toothbrushing reduces the incidence, duration, and mortality from pneumonia in community and hospital patients.

Key points

  • Presents moderate evidence of an association between oral health and two pulmonary conditions: chronic obstructive pulmonary disease (COPD) and pneumonia.

  • Presents strong evidence that frail populations (such as ventilated, or community-living and hospital-based patients) would have a lower incidence of pneumonia after regular oral hygiene interventions which include use of chlorhexidine or povidone iodine, with stronger evidence supporting chlorhexidine in mouthwash, gel, or other forms.

  • Highlights that although evidence suggests that chlorhexidine reduces the incidence of ventilator-associated pneumonia, other outcomes such as mortality are not affected.

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Acknowledgements

We would like to acknowledge the support of Public Health England, the Royal College of Surgeons, and the British Dental Association.

Author information

Affiliations

  1. Deputy Medical Director, Specialist in Special Care Dentistry, Northamptonshire Healthcare NHS Foundation Trust, Salaried Primary Care Dental Service, Willowbrook Health Centre, Cottingham Road, Corby, NN17 2UR

    • D. Manger
  2. Honorary Professor of Medicine, Department of Infection Microbiology and Immunology, Liverpool University and Consultant Chest Physician, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE

    • M. Walshaw
  3. Formerly Dental Core Trainee in Community Special Care Dentistry/Dental Public Health/Honorary Research Assistant

    • R. Fitzgerald
  4. Formerly Clinical Fellow in Special Care Dentistry, Northampton Healthcare NHS Foundation Trust, Academic Clinical Fellow in Special Care Dentistry, Eastman Dental Hospital, University College London, 256 Gray's Inn Road, London, WC1X 8LD

    • J. Doughty
  5. Senior Lecturer in Dental Public Health, University of Portsmouth Dental Academy, William Beatty Building, Hampshire Terrace, Portsmouth PO1 2QG

    • K. L. Wanyonyi
  6. Director of Dental Public Health, Population Health & Care Division, Health and Wellbeing Directorate, Public Health England, Skipton House, 80 London Road, London, SE1 6LH

    • S. White
  7. Head of Population and Patient Health, Newland Pedley Professor of Oral Health Strategy, Honorary Consultant in Dental Public Health, King's College London Dental Institute, Denmark Hill Campus, Bessemer Road, London, SE5 9RS

    • J. E. Gallagher

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Corresponding author

Correspondence to J. E. Gallagher.

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DOI

https://doi.org/10.1038/sj.bdj.2017.315

Refereed Paper

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