How Brushing Your Teeth in the Hospital Can Prevent Infections

Brushing your teeth while receiving hospital treatment can drastically lower your risk of pneumonia.

For various reasons, many patients in hospitals neglect to brush their teeth. Some may forget their toothbrush, some may not consider it, and others might lack the ability or inclination to do so. Additionally, healthcare personnel often overlook routine oral hygiene practices when caring for patients.

However, a significant randomized controlled trial revealed that patients who received tooth brushing, toothpaste, and dental hygiene advice during hospitalization were 60% less likely to develop pneumonia—a common hospital-acquired infection. This finding was highlighted by Brett Mitchell at Avondale University, Australia.

“This underscores the necessity of educating patients about pneumonia risks and the vital role of oral care during hospitalization,” he states.

Pneumonia often arises from medical devices that disrupt natural respiratory functions. However, many hospitalized individuals who are not on ventilators also develop pneumonia at least 48 hours post-admission. Researchers continue to investigate the causes and preventive measures of this condition, which is linked to longer hospital stays, increased healthcare costs, and higher mortality rates— research article.

“Addressing this is crucial,” notes Michael Klompas from Harvard University, who was not part of the study. “Hospital-acquired pneumonia is one of the most prevalent and dangerous healthcare-associated infections, yet there is a lack of substantial data on how to effectively prevent it.”

Mitchell suspected that bacteria in the mouth might be contributing to this issue. The oral microbiome can influence respiratory health since inhaling bacteria-laden droplets can introduce pathogens into the lungs. He points out that a hospitalized patient’s oral microbiome changes, making it important to address the problem.

To investigate, Mitchell and his colleagues launched a year-long randomized controlled trial involving 8,870 patients across three Australian hospitals to assess the effect of oral hygiene on pneumonia risk. He shared the findings from this segment of the Nosocomial Pneumonia Prevention (‘HAPPEN’) study at the international conference organized by the European Society for Clinical Microbiology and Infectious Diseases (ESCMID Global) in Munich, Germany.

Each hospital divided participants into three groups. No interventions were made during the initial three months. Following this period, one group was provided with toothbrushes and toothpaste featuring messages like “Brushing your teeth helps prevent pneumonia” and “Blow away pneumonia!” The brushes were designed with special handles for individuals with limited dexterity, and patients received QR codes linking to educational resources on the HAPPEN website.

After six months, the second group also received toothbrushes, and after nine months, the third group did as well. Consequently, all participants had the opportunity to practice tooth brushing for the final three months of the study.

For medical staff, the research team provided oral care training for nurses on the wards and offered professional guidance through their website. They also encouraged nursing staff to remind patients to brush and floss, assisting those who encountered difficulties.

During the pre-intervention phase, only 15.9% of patients brushed their teeth daily. In contrast, during the intervention phase, 61.5% of patients engaged in oral hygiene at least once a day, averaging 1.5 times per day. Web analytics showed frequent engagement from both patients and nurses with the HAPPEN resource during the intervention.

Notably, the incidence of hospital-acquired pneumonia not associated with ventilators decreased significantly—from 1 case per 100 hospital days in the control group to 0.41 cases in the intervention group.

“This study is noteworthy due to its large scale and randomized design,” says Klompas, emphasizing that brushing teeth during hospitalization not only promotes oral health but could potentially save lives.

Piry Sipila from the University of Helsinki highlights the significance of substantial risk reductions resulting from straightforward actions. “The intervention was simple: patients received a toothbrush, toothpaste, and practical advice,” he notes, but results may differ based on a patient’s hospital reason and existing oral hygiene habits.