Commentary: Munro CL et al. (2006). Oral health status and development of ventilator-associated pneumonia: a descriptive study.

Background: Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality and may be influenced by oral health. Objective: To describe the relationship between VAP and oral health status, changes in oral health status during the first 7 days after intubation and microbial colonization of the oropharynx and trachea. Methods: A total of 66 patients were enrolled within 24 h of intubation and were followed up for up to 7 days. Data on oral health measures and the clinical pulmonary infection score (CPIS) were collected at baseline, day 4 (n = 37) and day 7 (n = 21). A regression model was used to predict risk of pneumonia at day 4. Results: Dental plaque and oral organisms increased over time. Correlations were significant for baseline and day 4 dental plaque (P < 0.001), baseline salivary lactoferrin and day 4 plaque (P = 0.01), and lower salivary volume and higher day 4 CPIS (P = 0.02). Potential pathogens were identified in oral cultures for six patients before or at the same time as the appearance of the organisms in tracheal aspirates. Correlations were significant with day 4 CPIS for score on the Acute Physiology and Chronic Health Evaluation (APACHE) II (P = 0.007), day 4 salivary volume (P = 0.02), interaction of APACHE II score and day 1 CPIS (P < 0.001), and interaction of day 1 CPIS and plaque (P = 0.01). Conclusions: Higher dental plaque scores confer greater risk for VAP, particularly for patients with greater severity of illness. Salivary volume and lactoferrin may affect the risk.