RELATIONSHIPS BETWEEN PERIODONTAL-DISEASE AND BACTERIAL PNEUMONIA

BACTERIAL PNEUMONIA IS A PREVALENT AND COSTLY INFECTION that is a sign ificant cause of morbidity and mortality in patients of all ages. The continuing emergence of antibiotic-resistant bacteria (e.g., penicilli n-resistant pneumococci) suggests that bacterial pneumonia will assume increasing importance in the coming years. Thus, knowledge of the pat hogenesis of, and risk factors for, bacterial pneumonia is critical to the development of strategies for prevention and treatment of these i nfections. Bacterial pneumonia in adults is the result of aspiration o f oropharyngeal flora into the lower respiratory tract and failure of host defense mechanisms to eliminate the contaminating bacteria, which multiply in the lung and cause infection. It is recognized that commu nity-acquired pneumonia and lung abscesses can be the result of infect ion by anaerobic bacteria; dental plaque would seem to be a logical so urce of these bacteria, especially in patients with periodontal diseas e. It is also possible that patients with high risk for pneumonia, suc h as hospitalized patients and nursing home residents, are likely to p ay less attention to personal hygiene than healthy patients. One impor tant dimension of this personal neglect may be diminished attention to oral hygiene. Poor oral hygiene and periodontal disease may promote o ropharyngeal colonization by potential respiratory pathogens (PRPs) in cluding Enterobacteriaceae (Klebsiella pneumoniae, Escherichia coli, E nterobacter species, etc.), Pseudomonas aeruginosa, and Staphylococcus aureus. This paper provides the rationale for the development of this hypothesis especially as it pertains to mechanically ventilated inten sive care unit patients and nursing home residents, two patient groups with a high risk for bacterial pneumonia.