Safeguarding Against Aspiration Pneumonia Through Oral Hygiene

Oral care is essential for everyone, but for individuals who have trouble swallowing (dysphagia), it can be a matter of life and death. Poor oral hygiene increases the risk of aspiration pneumonia, a serious lung infection that occurs when bacteria from the mouth travel to the lungs, typically through inhaling food, liquid, or even saliva.

How Does Poor Oral Care Lead to Aspiration Pneumonia?

Poor oral care can lead to aspiration pneumonia because bacteria in the mouth can be inhaled into the lungs, causing infection. Without regular brushing, flossing, or cleaning dentures, bacteria build up on the teeth and gums. This is especially dangerous for people who can’t take care of their own oral hygiene, like older adults or those who need help from caregivers. If a person has trouble swallowing or controlling saliva, they might breathe in food, liquid, or saliva that contains bacteria from the mouth, which can enter the lungs and cause pneumonia. People with weaker immune systems, like older adults or those with chronic illnesses, are more likely to get sick once bacteria reach their lungs.

The Role of Caregivers in Oral Hygiene

Being dependent on another person for oral care is one of the strongest predictors of aspiration pneumonia. Why? Simply put, another person may not be able to clean someone else's mouth as effectively as the individual could themselves. This is why caregivers must receive proper training and understand the correct techniques for oral care. First, they should learn how to properly brush teeth, clean dentures, and perform mouth rinses, which involves knowing the right amount of pressure to apply, the best angles for reaching all areas of the mouth, and how to clean the tongue and soft tissues. Caregivers also need strong observation skills to recognize signs of oral health issues, such as sores, swelling, or changes in the person’s ability to eat or drink. Since oral care can sometimes be uncomfortable or distressing, caregivers must use strategies to make the process as comfortable as possible. It’s also important to adapt care to each individual’s needs, as these may change over time. When caregivers understand the connection between oral health and overall well-being, they’re more likely to prioritize thorough oral care. Finally, while daily care is essential, it should be supplemented with regular dental check-ups to ensure ongoing oral health.

How Often Should Oral Care Be Performed?

Ideally, oral care should be performed before and after meals, especially for individuals at high risk for aspiration pneumonia. If that's not always possible, aiming for 2-3 times a day (morning and night) is a great way to establish an effective oral hygiene routine.

Proper Oral Care Steps

For patients with teeth:

1. Sit the patient upright as much as possible.

2. Wear gloves, use a toothette– if available– a face shield and/or goggles. 

   1. A toothette is a small, disposable oral care sponge on a stick that is used to clean the mouth and teeth, especially for individuals who have difficulty using a toothbrush. 

      

3. Start by using a toothette or soft sponge to remove any visible secretions.

4. Use a toothbrush with a small amount of toothpaste to brush the teeth, tongue, and gums.

5. Rinse the mouth with water or a sponge dipped in water.

6. If possible, have the patient swish with mouthwash. If they cannot, use a clean swab dipped in mouthwash along the mouth's surfaces.

7. Apply mouth gel to sore spots and moisturize the lips.

For patients with dentures:

1. Follow the same steps above to clean the gums and tongue.

2. Remove the dentures and rinse them with cold water to remove debris.

3. Brush all surfaces of the dentures with denture paste or toothpaste, and rinse well.

4. Apply mouth gel to any sore spots and moisturize the lips if needed.

5. Soak the dentures overnight in a denture cleaner.

Signs of Poor Oral Care

How can you tell if someone’s oral hygiene is lacking? Look for these signs:

• White patches on the tongue

• A webbed or striped appearance on the tongue

• An intensely red tongue

• Dry, red, chapped lips

• Bad breath

• Food pocketed in the cheeks after swallowing

Maintaining proper oral care is a simple yet crucial step in reducing the risk of aspiration pneumonia, especially for individuals with swallowing difficulties or weakened immune systems. By establishing a consistent oral hygiene routine and ensuring thorough cleaning, caregivers can help protect their loved ones from serious health complications. Speech-language pathologists are valuable resources in guiding and educating on effective oral care practices, making it easier to keep mouths—and lungs—healthy.