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 Patients who visited a dentist were slightly less likely to have
post-surgery pneumonia or die within 30 days of surgery, the study
authors found.
"Oral care is one option for preventing postoperative pneumonia as
postoperative pneumonia can be precipitated by aspiration of oral
and pharyngeal secretions," said lead researcher Miho Ishimaru of
the University of Tokyo.
Respiratory germs can grow in biofilms and microorganisms on the
surface of the teeth and tongue. Dental care has been found to help
reduce pneumonia for patients on ventilators, the researchers wrote
in the British Journal of Surgery.
"Several studies have suggested that preoperative oral care might be
associated with a decrease in postoperative pneumonia, but these
were limited by small sample sizes," Ishimaru told Reuters Health by
email.
Ishimaru and colleagues analyzed national data on patients who
underwent surgery for cancers of the head, neck, esophagus, stomach,
lung, liver or colon and rectum at 1,600 hospitals between
2012-2015.
Of the 509,000 patients who had cancer surgery, about 81,600
received preoperative oral care.
About 15,700 patients developed postoperative pneumonia and 1,700
died within 30 days of surgery. Ultimately, preoperative oral care
was linked with a half-a-percentage-point decrease in the risk of
postoperative pneumonia and an eighth-of-a-percentage-point decrease
in all-cause mortality.
"I think these findings are interesting. However, while
statistically significant, one has to wonder how clinically relevant
they are because the differences are - on an absolute scale - quite
small," said Dr. Quoc-Dien Trinh, co-director of the Dana-Farber and
Brigham and Women's Prostate Cancer Program in Boston. Trinh, who
wasn't involved with this study, has researched pneumonia after
major cancer surgery.
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"The authors correctly point out that unmeasured confounders may
have influenced their results," Trinh told Reuters Health by email.
"For example, perhaps the surgeons/hospitals who refer patients to
preoperative dental care are 'better' and are less likely to develop
pneumonia."
A randomized controlled trial could help researchers better
understand the connections, Trinh said. Separating different types
of cancers could illuminate differences, as could studying different
countries.
In the U.S., "head and neck cancers almost always have a mandatory
dental exam if there is any question because they get radiation
often as part of their treatment," said Dr. Sherry Wren of Stanford
University and Palo Alto Veterans Hospital in California. Wren, who
wasn't involved with this study, has researched the long-term
results of a postoperative pneumonia prevention program.
Wren and colleagues found that pneumonia cases at the Veterans
Affairs hospital dropped 44 percent in the four years after they
implemented the prevention program. The strategies include training
with nursing staff about pneumonia prevention, coughing and
deep-breathing exercises, twice-daily oral hygiene, head-of-bed
elevation and sitting up for all meals, and good pain control.
"I think clinicians should at least consider preoperative dental
care prior to a complex cancer surgery, especially given the
established relationship between postoperative pneumonia and
postoperative mortality," Trinh said.
SOURCE: http://bit.ly/2Ns0a0H British Journal of Surgery, online
August 8, 2018.
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