Aspiration pneumonia: dental and oral risk factors in an older veteran population.

OBJECTIVES

To investigate the importance of medical and dental factors in aspiration pneumonia in an older veteran population.

DESIGN

Prospective enrollment of subjects with retrospective analysis of data.

SETTING

Department of Veterans Affairs outpatient clinic, inpatient ward, and nursing home.

PARTICIPANTS

358 veterans age 55 and older; 50 subjects with aspiration pneumonia.

MEASUREMENTS: Demographic and medical data; functional status; health-related behaviors; dental care utilization; personal oral hygiene; comprehensive dental examination; salivary assays including IgA antibodies; and cultures of saliva, throat, and dental plaques.

RESULTS

Two logistic regression models produced estimates of significant risk factors. One model using dentate patients included: requiring help with feeding (odds ratio (OR) = 13.9), chronic obstructive pulmonary disease (COPD) (OR = 4.7), diabetes mellitus (OR = 3.5), number of decayed teeth (OR = 1.2), number of functional dental units (OR = 1.2), presence of important organisms for decay, Streptococcus sobrinus in saliva (OR = 6.2), and periodontal disease, Porphyromonous gingivalis in dental plaque (OR = 4.2), and Staphylococcus aureus presence in saliva (OR = 7.4). The second model, containing both dentate and edentulous patients included: requiring help with feeding (OR = 4.7), COPD (OR = 2.5), diabetes mellitus (OR = 1.7), and presence of S. aureus in saliva (OR = 8.3).

CONCLUSION

This study supports the significance of oral and dental factors while controlling for established medical risk factors in aspiration pneumonia incidence.