I read with interest Dr. Gordon Christensen’s August JADA article, "Special Oral Hygiene and Preventive Care for Special Needs" (
JADA 2005;136:1141–3
). This is an important and often overlooked issue. Dr. Christensen rightly indicates that high-risk groups, such as the intellectually and physically disabled, as well as those with high caries and periodontal disease activity, require additional vigilance and interventions to prevent oral disease activity.
I would like to point out two additional overlooked populations in this regard: hospitalized patients and nursing home residents. Subjects admitted to hospital intensive care units or nursing homes often are found to have more dental plaque than do community-dwelling people.
These patients also harbor bacteria such as Pseudomonas aeruginosa, Staphylococcus aureus and enteric bacteria on the teeth.1 These bacteria then may be released into the oral secretions, to be aspirated into the lower airway to cause infection. It also is possible that inflammatory mediators, such as cytokines produced by the periodontium released into the secretions, can be aspirated to have proinflammatory effects in the lower airway. Accumulating evidence suggests that the oral health status of institutionalized subjects contributes to a higher risk of developing lung infections.2 Thus, it is increasingly clear that preventive interventions to maintain oral health are required in this group of patients.
In addition, it was surprising to note that Dr. Christensen did not mention the use of chlorhexidine products for plaque control in high-risk patients. It has long been known that chlorhexidine rinses (Peridex, Zila, Phoenix; PerioGard, Colgate Oral Pharmaceuticals, Canton, Mass.) reduce gingival inflammation in periodontal patients.
Other studies have shown that chlorhexidine rinse and varnish reduce Streptococcus mutans levels in patients with coronal and root caries.3,4 These products also may serve to reduce the risk of developing pneumonia and other diseases in ventilated patients, other hospitalized patients, patients undergoing cancer chemotherapy and nursing home patients.2,5
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