How Good Oral Health Can Reduce Ventilator-Associated Pneumonia

Ventilator-associated pneumonia (VAP) is serious, deadly and not uncommon for individuals connected to a mechanical ventilator. What many don’t know, however, is the close relationship between VAP and oral healthcare. Because of the increase in individuals on ventilators due to COVID-19, awareness of this connection could decrease cases of VAP and save lives.

VAP is the second most common hospital acquired infection (HAI), occurring in 10-20% of patients ventilated for more than 48 hours, and the leading cause of HAI death among critically ill patients. Good oral health can substantially reduce the incidence of VAP, studies show. Preventive dental visits were associated with a decreased likelihood of acquiring VAP. Some of the study’s findings were that:

• At least one preventive dental visit within three years before ventilation was associated with a 22% reduction in the likelihood of VAP.
• Each additional routine dental visit over the previous three years decreased the probability of a VAP diagnosis by 5%.

Lacking or neglected oral care can hurt the oral microbiome and allow pathogenic organisms to be harbored on the tooth surface. Routinely visiting the dentist helps keep plague and bacteria from accumulating on the teeth, reducing the risk of VAP for ventilated patients.

During the recent COVID-19 pandemic, there has been an increase in individuals in the ICU and on ventilators. COVID-19 has disproportionately affected people of color in the United States, who have been shown to have worse outcomes with VAP. It’s important to take into account the historic disparities in health care when identifying and assessing at-risk patients.

VAP occurs when a patient is connected to a mechanical ventilator, and bacteria from the mouth or equipment moves into the lungs. The tube in the airway allows bacteria in the mouth to evade the natural defenses present in the oral microbiome that would normally inhibit the movement of bacteria to the lungs.

In conclusion, some of the best ways to prevent VAP are to:

• Promote oral health care and behaviors in the community
• Heighten effective oral care for patients at risk of VAP, taking into account historic disparities
• Implement oral care management protocols for all patients on ventilators

For more information on ventilation in the ICU, read our physician blog on the topic. MLMIC encourages dentists to monitor all COVID-19-related updates on our resources page and continue to monitor our blog for additional guidance on safely managing practices during the pandemic.