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Oral Health and Mortality Risk From Pneumonia
Howard E. Strassler, DMD
Awano S, Ansai T, Takata Y, et al. J Dent Res. 2008;87(4): 334-339.
Although poor oral health influences the occurrence of pulmonary infection in elderly people, it is unclear how the degree of oral health is linked to mortality from pulmonary infection. Therefore, we evaluated the relationship between oral health and 4-year mortality from pneumonia in an elderly Japanese population. The study population consisted of 697 (277 males, 420 females) of the 1,282 individuals who were 80 years old in 1997. Data on oral and systemic health were obtained by means of questionnaires, physical examinations, and laboratory blood tests. One hundred eight of the study persons died between 1998 and 2002. Of these, 22 deaths were due to pneumonia. The adjusted mortality due to pneumonia was 3.9 times higher in persons with 10 or more teeth with a probing depth exceeding 4 mm (periodontal pocket) than in those without periodontal pockets. Therefore, the increase in teeth with periodontal pockets in the elderly may be associated with increased mortality from pneumonia.
Inflammation has been implicated in many chronic diseases. Recent research supports the role of dental inflammatory processes as a risk factor and a marker for coronary heart disease (CHD). In recent years, a number of studies have demonstrated the association between periodontal conditions caused by bacterial infection and coronary heart disease.1-3 Also, acute or chronic inflammatory lesions around the apex of a tooth usually are caused by bacterial infection and, while there are differences between chronic inflammatory periodontal diseases and those of endodontic derivation, there are also some similarities, including the presence of gram-negative anaerobic organisms and elevated systemic cytokine levels.4 While the pathways by which a chronic oral infection can lead to cardiovascular disease have been controversial, it has been hypothesized that there can be two different courses: (1) direct invasion of the arterial wall by periodontal pathogens; and (2) the release of systemic inflammatory mediators with atherogenic effects in response to infection. Based on current evidence of the role of inflammation in cardiovascular disease, the possibility exists that other disorders characterized by inflammation, such as periodontal diseases and endodontic infections, may have an indirect role by influencing the risk, manifestation, and progression of vascular events.
The researchers of this study investigated the relationship between the oral health status of an elderly Japanese population and mortality risk from pneumonia. Oral anaerobic bacteria that have been implicated in periodontal diseases were identified from sputum samples of aspiration pneumonia in elderly patients. Over a 4-year period, 22 deaths from a population of 108 were recorded. The adjusted mortality caused by pneumonia was 3.9 times higher when the patient had periodontal diseases and 10 or more teeth. This information is important not only for dental offices treating older patients, but also any dentist that works with nursing homes and assisted-living facilities. For patients identified as being at risk for pneumonia, more frequent visits for periodontal treatment may decrease their risk of death from pneumonia.
1. Humphrey LL, Fu R, Buckley DI, et al. Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis. J Gen Intern Med. 2008 Sept 20. Epub ahead of print.
2. Ridker PM, Silvertown JD. Inflammation, C-reactive protein, and atherothrombosis. J Periodontol. 2008;79(8 Suppl):1544-1551.
3. Niedzielska I, Janic T, Cierpka S, et al. The effect of chronic periodontitis on the development of atherosclerosis: review of the literature. Med Sci Monit. 2008;14(7):RA103-106.
4. Caplan DJ, Chasen JB, Krall EA, et al. Lesions of endodontic origin and risk of coronary heart disease. J Dent Res. 2006;85(11): 996-1000.
About the Author
Howard E. Strassler, DMD
Professor and Director of Operative Dentistry
Department of Endodontics, Prosthodontics and Operative Dentistry
University of Maryland Dental School