(By Dr. Joseph D. Lim and Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI)
ANOTHER review presents moderate evidence of an association between oral health and two pulmonary conditions: chronic obstructive pulmonary disease (COPD) and pneumonia.
The cumulative evidence suggests an association between oral and pulmonary disease, specifically COPD and pneumonia, says D. Manger, Deputy Medical Director, Specialist in Special Care Dentistry, Northamptonshire, who led the review.
Pneumonia 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.
Pulmonary diseases can be broadly divided into lung infections, lung cancer, and those which obstruct airflow (chronic obstructive pulmonary disease and asthma).
Pneumonia is an inflammation of the lung, usually caused by infection. Three common causes are bacteria, viruses and fungi, which may colonize the oral cavity and upper airway.
Chronic obstructive pulmonary disease is a type of obstructive lung disease characterized by chronically poor airflow. The main symptoms include shortness of breath, cough, and sputum. Tobacco smoking is the most common cause of COPD, with a number of other factors such as air pollution and genetics playing a smaller role.
The review suggests that there is biological plausibility for a causal link between pulmonary disease and oral health related to oral disease pathogens aspirated into the pulmonary tissues. In the absence of effective oral care, initial plaque formation will occur within 48 hours; the composition of the oropharyngeal flora becomes more heavily colonized by virulent gram-negative pathogens that, as well as leading to oral disease, may be transported to the lungs where they have the potential to cause respiratory infections.
The aim of good mouth care is to maintain oral cleanliness, remove plaque and thereby prevent infection. Twice daily brushing is recommended to control both periodontal diseases and caries. However, the extent to which this may impact on pulmonary disease is unclear. In view of the serious outcomes and high prevalence related to both pulmonary and oral diseases, the review collated the most contemporary evidence on any links between the two.
Overall the literature suggests associations of varying strength between oral health (periodontitis, caries, and plaque) and pulmonary disease (COPD and pneumonia), Manger says. “This was demonstrated by the increased presence of oral disease, or oral pathogens, in those (study) participants who developed pulmonary disease when compared with those who did not.”
No evidence was discovered regarding any association between oral health and the presence of other conditions, notably lung cancer or tuberculosis.
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Dr. Joseph D. Lim, Ed. D., is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; Honorary Life Member of the Thai Association of Dental Implantology; and Founding Chairman of the Philippine College of Oral Implantologists. For questions on dental health, e-mail or text 0917-8591515.
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Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines, College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De la Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate Professor; Fellow, International Congress of Oral Implantologists; Member, American Academy of Implant Dentistry and Fellow, Philippine College of Oral Implantologists. For questions on dental health, e-mail./PN
