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Mouthing Off

Aspiration and Oral Care

Aspiration alone does not always lead to pneumonia.  Pneumonia from aspiration is caused by the ingestion of a very large load of bacteria into the lower respiratory system where the infestation overwhelms the weakened immune system protection.  Why is it that all dysphagic patients do not develop pneumonia?  For a person to develop pneumonia from aspiration, the person must be significantly ill.  A severe illness causes a stress response, which lowers the body’s immune system’s ability to fight off bacteria.  The illness may be a CVA, surgery, heart attack, etc.  Pneumonia does not occur by itself; it is a result of the serious illness and may occur 3 to 7 days after the medical event.

There is controversy over where this bacteria comes from in a dysphagic patient.  Some people believe it is the mouth, others believe it is the stomach.  There is a great amount of research that documents the increase in gram-negative (anaerobic) bacteria in the oral cavity following the onset of a serious illness.  One of the roles of saliva and mucous is to fight bacteria through their immune properties.  The stress response causes a decrease or cessation of saliva and oral mucous secretion in the oral cavity.  This allows bacteria that is already and always in the oral cavity to multiply.  The mouth must be cleaned regularly and well to prevent the over-development of bacteria in seriously ill patients and to prevent potential pneumonia from bacterial aspiration.  It has been effective to brush one to three times a day.  Toothbrushes with suction tubes to catch secretions and to help prevent dislodging and swallowing of bacteria are being used.  It has been found that green sponges and lemon-glycerine swabs may do more harm than good.  The glycerine swabs alone moisten the mouth, but do not clean it.  The lemon additive may act to dry out the mucosa of the mouth; which is the opposite of what is desired.