A recent article in the Journal of Periodontology highlighted an interesting potential relationship between pathogenic bacteria in the oral cavity which results in periodontal diseases and their relationship to bacterial pneumonia in compromised patients. With more and more bacteria showing antibiotic resistance, it becomes increasingly important to adequately identify and control the known sources of bacterial contamination in patients that suffer from both periodontal diseases and pulmonary diseases.

In the review article "Relationships Between Periodontal Disease and Bacterial Pneumonia," by Scannapieco and Mylotte, they review the literature indicating that a number of respiratory pathogens identified in multiple case reports correspond to known periodontal disease causing organisms. Most periodontal diseases are chronic infections of the tissues surrounding the teeth. The infections are generally of mixed bacterial origin, with the major pathogens being gram negative anaerobes. The soft tissue and bone destruction associated with periodontitis is the leading cause of tooth loss in adults. This chronic infection is known to be exacerbated by various medical conditions such as diabetes and sex hormone fluctuations and also has recently been implicated as a potential risk factor in complications resulting from cardiovascular diseases, diabetes and pregnancy.

In a series of clinical studies these trends were reinforced when MICU patients in both a VA and community hospital setting were retrospectively studied both in terms of their respiratory infections and oral bacterial contaminations.

In addressing strategies to deal with reducing the risk of respiratory infections resulting from periodontal pathogens, the authors reviewed the limitations of current oral disinfection techniques and concluded by saying that "fastidious infection control remains the cornerstone of prevention. Surveillance of potential pathogens, identification of high risk patients, staff education, ... all have had a positive impact on diminishing nosocomial pneumonia. Additional attention to oral hygiene may further diminish the risk of nosocomial pneumonia."

Additional studies to evaluate the effects of improved dental care and periodontal management of disease in patients who are at high risk for pulmonary diseases is certainly appropriate. We have communicated this information to local pulmonary specialists in hopes that they will appreciate, as we do, the importance of good oral health to patients' medical health including their pulmonary status.