Abstract
BackgroundAspiration pneumonia is a serious and fatal complication of dysphagia, secondary to the ingestion of bacteria-laden secretions. However, no studies have documented the oral hygiene features present in patients who present with dysphagia.ObjectivesThe purpose of this study was to describe the oral hygiene problems of adults admitted to a sub-acute rehabilitation hospital and who presented with dysphagia.MethodsA descriptive, cross-sectional survey was conducted, during which 40 participants – 57.5% (n = 23) male and 42.5% (n = 17) female – underwent a clinical swallow evaluation using the Mann Assessment of Swallowing Ability (MASA) augmented with cervical auscultation (CA) and pulse oximetry (PO), an oral hygiene assessment using an adapted version of the Oral Health Assessment Tool (OHAT), followed by microbiology laboratory analysis of buccal swab samples to detect bacteria not considered part of the normal oral flora.ResultsResults indicated that poor oral hygiene status was a common feature amongst all participants who presented with dysphagia. The most prevalent oral hygiene issues were related to abnormalities concerning saliva (60%), oral cleanliness (82.5%), the tongue (80%) and the use of dentures (71.4%). A high prevalence, 62.5% (n = 25), of opportunistic bacteria was found. The most commonly occurring bacteria groups were: (1) Candida albicans (47.5%) and (2) respiratory pathogens (37.5%) such as Klebsiella pneumoniae and Staphylococcus aureus.ConclusionPersons with dysphagia have poor oral hygiene which creates favourable environments for bacteria to flourish and increases the prevalence of pathogenic oral bacteria associated with the development of aspiration pneumonia. The management of oral health issues for persons with dysphagia should receive greater attention during hospitalisation.
Highlights
The oral cavity of hospitalised and bedridden patients is often a reservoir for opportunistic respiratory pathogens (Boaden et al, 2017; Tada & Miura, 2012), and can serve as a source of infection for the lungs if aspirated
As the study aimed to investigate oral hygiene issues present in patients with dysphagia the decision was made to include participants who presented with a Mann Assessment of Swallowing Ability (MASA) score of ≥ 178 indicating little evidence of disease (LED), as these patients still presented with lower scores in the oral preparatory phase and oral phases of the swallow
This study demonstrated that the oral hygiene status of hospitalised patients who present with dysphagia is concerning
Summary
The oral cavity of hospitalised and bedridden patients is often a reservoir for opportunistic respiratory pathogens (Boaden et al, 2017; Tada & Miura, 2012), and can serve as a source of infection for the lungs if aspirated. The incidence of pneumonia caused by aspiration of pathogenic bacteria in patients who present with dysphagia, increases both the mortality and the need for acute care hospitalisation (Sørensen et al, 2013), which in turn can impact on oral hygiene (Danckert, Plummer, & Williams, 2016; Neto, De Paula Ramos, Sant’ana, & Passanezi, 2011; Tada & Hanada, 2010). This is partly because of the fact that oral infections often remain asymptomatic and may still result in bacteraemia despite an absence of overt symptoms (Rautemaa, Lauhio, Cullinan, & Seymour, 2007). No studies have documented the oral hygiene features present in patients who present with dysphagia
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