Denture wearing during sleep doubles the risk of pneumonia in the very elderly

T. Iinuma, Yasumichi Arai, Y. Abe, Michiyo Takayama, M. Fukumoto, Y. Fukui, T. Iwase, Toru Takebayashi, N. Hirose, N. Gionhaku, K. Komiyama

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Poor oral health and hygiene are increasingly recognized as major risk factors for pneumonia among the elderly. To identify modifiable oral health-related risk factors, we prospectively investigated associations between a constellation of oral health behaviors and incident pneumonia in the community-living very elderly (i.e., 85 years of age or older). At baseline, 524 randomly selected seniors (228 men and 296 women; mean age, 87.8 years) were examined for oral health status and oral hygiene behaviors as well as medical assessment, including blood chemistry analysis, and followed up annually until first hospitalization for or death from pneumonia. During a 3-year follow-up period, 48 events associated with pneumonia (20 deaths and 28 acute hospitalizations) were identified. Among 453 denture wearers, 186 (40.8%) who wore their dentures during sleep were at higher risk for pneumonia than those who removed their dentures at night (log rank P = 0.021). In a multivariate Cox model, both perceived swallowing difficulties and overnight denture wearing were independently associated with an approximately 2.3-fold higher risk of the incidence of pneumonia (for perceived swallowing difficulties, hazard ratio [HR], 2.31; and 95% confidence interval [CI], 1.11-4.82; and for denture wearing during sleep, HR, 2.38; and 95% CI, 1.25-4.56), which was comparable with the HR attributable to cognitive impairment (HR, 2.15; 95% CI, 1.06-4.34), history of stroke (HR, 2.46; 95% CI, 1.13-5.35), and respiratory disease (HR, 2.25; 95% CI, 1.20-4.23). In addition, those who wore dentures during sleep were more likely to have tongue and denture plaque, gum inflammation, positive culture for Candida albicans, and higher levels of circulating interleukin-6 as compared with their counterparts. This study provided empirical evidence that denture wearing during sleep is associated not only with oral inflammatory and microbial burden but also with incident pneumonia, suggesting potential implications of oral hygiene programs for pneumonia prevention in the community.

Original languageEnglish
Pages (from-to)28S-36S
JournalJournal of Dental Research
Volume94
DOIs
Publication statusPublished - 2015 Mar 25

Fingerprint

Dentures
Pneumonia
Sleep
Oral Health
Confidence Intervals
Oral Hygiene
Deglutition
Hospitalization
Health Behavior
Gingiva
Candida albicans
Tongue
Proportional Hazards Models
Health Status
Interleukin-6
Stroke
Inflammation
Incidence

Keywords

  • Candida albicans
  • infection
  • interleukin-6
  • oral hygiene
  • pneumonitis
  • very old

ASJC Scopus subject areas

  • Dentistry(all)
  • Medicine(all)

Cite this

Denture wearing during sleep doubles the risk of pneumonia in the very elderly. / Iinuma, T.; Arai, Yasumichi; Abe, Y.; Takayama, Michiyo; Fukumoto, M.; Fukui, Y.; Iwase, T.; Takebayashi, Toru; Hirose, N.; Gionhaku, N.; Komiyama, K.

In: Journal of Dental Research, Vol. 94, 25.03.2015, p. 28S-36S.

Research output: Contribution to journalArticle

Iinuma, T, Arai, Y, Abe, Y, Takayama, M, Fukumoto, M, Fukui, Y, Iwase, T, Takebayashi, T, Hirose, N, Gionhaku, N & Komiyama, K 2015, 'Denture wearing during sleep doubles the risk of pneumonia in the very elderly', Journal of Dental Research, vol. 94, pp. 28S-36S. https://doi.org/10.1177/0022034514552493
Iinuma, T. ; Arai, Yasumichi ; Abe, Y. ; Takayama, Michiyo ; Fukumoto, M. ; Fukui, Y. ; Iwase, T. ; Takebayashi, Toru ; Hirose, N. ; Gionhaku, N. ; Komiyama, K. / Denture wearing during sleep doubles the risk of pneumonia in the very elderly. In: Journal of Dental Research. 2015 ; Vol. 94. pp. 28S-36S.
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abstract = "Poor oral health and hygiene are increasingly recognized as major risk factors for pneumonia among the elderly. To identify modifiable oral health-related risk factors, we prospectively investigated associations between a constellation of oral health behaviors and incident pneumonia in the community-living very elderly (i.e., 85 years of age or older). At baseline, 524 randomly selected seniors (228 men and 296 women; mean age, 87.8 years) were examined for oral health status and oral hygiene behaviors as well as medical assessment, including blood chemistry analysis, and followed up annually until first hospitalization for or death from pneumonia. During a 3-year follow-up period, 48 events associated with pneumonia (20 deaths and 28 acute hospitalizations) were identified. Among 453 denture wearers, 186 (40.8{\%}) who wore their dentures during sleep were at higher risk for pneumonia than those who removed their dentures at night (log rank P = 0.021). In a multivariate Cox model, both perceived swallowing difficulties and overnight denture wearing were independently associated with an approximately 2.3-fold higher risk of the incidence of pneumonia (for perceived swallowing difficulties, hazard ratio [HR], 2.31; and 95{\%} confidence interval [CI], 1.11-4.82; and for denture wearing during sleep, HR, 2.38; and 95{\%} CI, 1.25-4.56), which was comparable with the HR attributable to cognitive impairment (HR, 2.15; 95{\%} CI, 1.06-4.34), history of stroke (HR, 2.46; 95{\%} CI, 1.13-5.35), and respiratory disease (HR, 2.25; 95{\%} CI, 1.20-4.23). In addition, those who wore dentures during sleep were more likely to have tongue and denture plaque, gum inflammation, positive culture for Candida albicans, and higher levels of circulating interleukin-6 as compared with their counterparts. This study provided empirical evidence that denture wearing during sleep is associated not only with oral inflammatory and microbial burden but also with incident pneumonia, suggesting potential implications of oral hygiene programs for pneumonia prevention in the community.",
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