Oral Biofilms, Systemic Disease, and Pneumonia

  • M. P. Wise
  • D. W. Williams
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM, volume 2012)


Physicians are taught at an early stage of training to incorporate inspection of the oral cavity as part of their routine clinical examination. Structures within the mouth may be involved by local disease processes, such as tumor and infection, or demonstrate manifestations of systemic disorders. Medical education usually focuses on the latter, as observation of a pathognomonic sign immediately discloses the diagnosis of an often complex multisystem disorder. Typically this facilitates a focused clinical examination and additional relevant history to be elicited. Unfortunately, patients with the ulceration of Behcet’s disease, pigmentation of Addison’s disease or the characteristic macules of Peutz-Jeghers syndrome occur infrequently and the oral cavity may receive relatively little further consideration in a patient’s well-being. The one notable exception is infective endocarditis, which invariably prompts a close inspection of the teeth for a potential portal of infection entry. Critical care physicians are probably more likely to consider the oral cavity in patient management, but until recently this may have been limited to processes such as a dental abscess as a source of severe sepsis, aspiration pneumonitis, airway foreign body, oropharyngeal candidosis and intubation.


Oral Hygiene Dental Plaque Oral Care Porphyromonas Gingivalis Secretory Leukocyte Protease Inhibitor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Friedewald VE, Kornman KS, Beck JD, et al (2009) (2009) The American Journal of Cardiology and Journal of Periodontology Editors’ Consensus: Periodontitis and atherosclerotic cardiovascular disease. Am J Cardiol 104: 59–68PubMedCrossRefGoogle Scholar
  2. 2.
    Preshaw PM (2009) Periodontal disease and diabetes. J Dent 37: S 575–577CrossRefGoogle Scholar
  3. 3.
    Raghavendran K, Mylotte JM, Scannapieco FA (2007) Nursing home-associated pneumonia, hospital-acquired pneumonia and ventilator-associated pneumonia: the contribution of dental biofilms and periodontal inflammation. Periodontol 2000 44: 164–177PubMedCrossRefGoogle Scholar
  4. 4.
    Zijnge V, van Leeuwen MB, Degener JE, et al. (2010) Oral biofilm architecture on natural teeth. PloS One 5:e9321PubMedCrossRefGoogle Scholar
  5. 5.
    Oggioni MR, Trappetti C, Kadioglu A, et al (2006) Switch from planktonic to sessile life: a major event in pneumococcal pathogenesis. Mol Microbiol 61: 1196–1210PubMedCrossRefGoogle Scholar
  6. 6.
    Foreman A, Wormald PJ (2010) Different biofilms, different disease? A clinical outcomes study. Laryngoscope 120: 1701–1706PubMedCrossRefGoogle Scholar
  7. 7.
    Hall-Stoodley L, Stoodley P (2009) Evolving concepts in biofilm infections. Cell Microbiol 1034–1043Google Scholar
  8. 8.
    Telang NV, Satpute MG, Niphadkar KB, Joshi SG (2010) An increased incidence of biofilmproducing multidrug resistant methicillin-resistant Staphylococcus aureus in a tertiary care hospital from India. Am J Infect Control 38: 165–166PubMedCrossRefGoogle Scholar
  9. 9.
    McQueary CN, Actis LA (2011) Acinetobacter Baumannii biofilms: variations among strains and correlations with other cell properties. J Microbiol 49: 243–250PubMedCrossRefGoogle Scholar
  10. 10.
    Jakubovics NS, Kolenbrander PE (2010) The road to ruin: the formation of disease associated oral biofilms. Oral Dis 16: 729–739PubMedCrossRefGoogle Scholar
  11. 11.
    Oie S, Huang Y, Kamiya A, et al (1996) Efficacy of disinfectants against biofilm cells of methicillin-resistant Staphylococcus aureus. Micribios 85: 223–230Google Scholar
  12. 12.
    Pihlstrom BL, Michalowicz BS, Johnson NW (2005) Periodontal diseases. Lancet 366: 1809–1820PubMedCrossRefGoogle Scholar
  13. 13.
    Hujoel PP, White BA, García RI, Listgarten (MA 2001) The dentogingival epithelial surface area revisited. J Periodontal Res 36: 48–55PubMedCrossRefGoogle Scholar
  14. 14.
    Nakano K, Wada K, Nomura R, et al (2011) Characterization of aortic aneurysms in cardiovascular disease patients harboring Porphyromonas gingivalis. Oral Dis 17: 370–378PubMedCrossRefGoogle Scholar
  15. 15.
    Nakano K, Inaba H, Nomura R, et al (2008) Distribution of Porphyromonas gingivalis fimA genotypes in cardiovascular specimens from Japanese patients. Oral Microbiol Immunol 23: 170–172PubMedCrossRefGoogle Scholar
  16. 16.
    Figuero E, Sanchez-Beltran M, Cuesta-Frechoso S, et al (2011) Detection of periodontal bacteria in atheromatous plaques by nested polymerase chain reaction. J Periodontol 82: 1469–1477PubMedCrossRefGoogle Scholar
  17. 17.
    Delbosc S, Alsac JM, Journe C, et al (2011) Porphyromonas gingivalis participates in pathogenesis of human abdominal aortic aneurysm by neutrophil activation. Proof of concept in rats. PLoS One 6: e18679PubMedCrossRefGoogle Scholar
  18. 18.
    Gibson FC 3rd, Hong C, Chou HH, et al (2004) Innate immune recognition of invasive bacteria accelerates atherosclerosis in apolipoprotein E-deficient mice. Circulation 109: 2801–2806PubMedCrossRefGoogle Scholar
  19. 19.
    Hayashi C, Madrigal AG, Liu X, et al (2010) Pathogen-mediated inflammatory atherosclerosis is mediated in part via Toll-like receptor 2-induced inflammatory responses. J Innate Immun 2: 334–343PubMedCrossRefGoogle Scholar
  20. 20.
    Tonetti MS, D’Aiuto F, Nibali L, et al (2007) Treatment of periodontitis and endothelial function. N Engl J Med 356: 911–920PubMedCrossRefGoogle Scholar
  21. 21.
    Löe H (1993) Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care 16: 329–334PubMedGoogle Scholar
  22. 22.
    Emrich LJ, Shlossman M, Genco RJ (1991) Periodontal disease in non-insulin-dependent diabetes mellitus. J Periodontol 1991 62: 123–131CrossRefGoogle Scholar
  23. 23.
    Nesse W, Linde A, Abbas F, et al (2009) Dose-response relationship between periodontal inflamed surface area and HbA1c in type 2 diabetics. J Clin Periodontol 36: 295–300PubMedCrossRefGoogle Scholar
  24. 24.
    Koromantzos PA, Makrilakis K, Dereka X, Katsilambros N, Vrotsos IA, Madianos PN (2011) A randomized, controlled trial on the effect of non-surgical periodontal therapy in patients with type 2 diabetes. Part I: effect on periodontal status and glycaemic control. J Clin Periodontol 38: 142–147PubMedCrossRefGoogle Scholar
  25. 25.
    Navarro-Sanchez AB, Faria-Almeida R, Bascones-Martinez A (2007) Effect of non-surgical periodontal therapy on clinical and immunological response and glycaemic control in type 2 diabetic patients with moderate periodontitis J Clin Periodontol 34: 835–843PubMedCrossRefGoogle Scholar
  26. 26.
    Charlson ES, Bittinger K, Haas AR, et al (2011) Topographical continuity of bacterial populations in the healthy human respiratory tract. Am J Respir Crit Care Med 184: 957–963PubMedCrossRefGoogle Scholar
  27. 27.
    Gleeson K, Eggli DF, Maxwell SL (1997) Quantitative aspiration during sleep in normal subjects. Chest 111: 1266–1272PubMedCrossRefGoogle Scholar
  28. 28.
    Almirall J, Bolíbar I, Serra-Prat M, et al (2008) New evidence of risk factors for community-acquired pneumonia: a population-based study. Eur Respir J 31: 1274–1284PubMedCrossRefGoogle Scholar
  29. 29.
    Terpenning MS, Taylor GW, Lopatin DE, Kerr CK, Dominguez BL, Loesche WJ (2001) Aspiration pneumonia: dental and oral risk factors in an older veteran population. J Am Geriatr Soc 49: 557–563PubMedCrossRefGoogle Scholar
  30. 30.
    Quagliarello V, Ginter S, Han L, Van Ness P, Allore H, Tinetti M (2005) Modifiable risk factors for nursing home-acquired pneumonia. Clin Infect Dis 40: 1–6PubMedCrossRefGoogle Scholar
  31. 31.
    Russell SL, Boylan RJ, Kaslick RS, Scannapieco FA, Katz RV (1999) Respiratory pathogen colonization of the dental plaque of institutionalized elders. Spec Care Dentist 19: 128–134PubMedCrossRefGoogle Scholar
  32. 32.
    Sumi Y, Miura H, Michiwaki Y, Nagaosa S, Nagaya M (2007) Colonization of dental plaque by respiratory pathogens in dependent elderly. Arch Gerontol Geriatr 44: 119–124PubMedCrossRefGoogle Scholar
  33. 33.
    Yoneyama T, Yoshida M, Ohrui T, et al (2002) Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 50: 430–433PubMedCrossRefGoogle Scholar
  34. 34.
    Sjögren P, Nilsson E, Forsell M, Johansson O, Hoogstraate J (2008) A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc 56: 2124–2130PubMedCrossRefGoogle Scholar
  35. 35.
    Rello J, Lode H, Cornaglia G, Masterton R (2010) A European care bundle for prevention of ventilator-associated pneumonia. Intensive Care Med 36: 773–780PubMedCrossRefGoogle Scholar
  36. 36.
    Fourrier F, Duvivier B, Boutigny H, Roussel-Delvallez M, Chopin C (1998) Colonization of dental plaque: a source of nosocomial infections in intensive care unit patients. Crit Care Med 26: 301–308PubMedCrossRefGoogle Scholar
  37. 37.
    Dennesen P, van der Ven A, Vlasveld M, et al (2003) Inadequate salivary flow and poor oral mucosal status in intubated intensive care unit patients. Crit Care Med 31: 781–786PubMedCrossRefGoogle Scholar
  38. 38.
    Garrouste-Orgeas M, Chevret S, Arlet G, et al (1997) Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients. A prospective study based on genomic DNA analysis. Am J Respir Crit Care Med 156: 1647–1655PubMedCrossRefGoogle Scholar
  39. 39.
    Rello J, Koulenti D, Blot S, et al (2007) Oral care practices in intensive care units: a survey of 59 European ICUs. Intensive Care Med 33: 1066–1070PubMedCrossRefGoogle Scholar
  40. 40.
    Binkley C, Furr LA, Carrico R, McCurren C (2004) Survey of oral care practices in US intensive care units. Am J Infect Control 32: 161–169PubMedCrossRefGoogle Scholar
  41. 41.
    Needleman IG, Hirsch NP, Leemans M, et al (2011) Randomized controlled trial of tooth-brushing to reduce ventilator-associated pneumonia pathogens and dental plaque in a critical care unit. J Clin Periodontol 38: 246–252PubMedCrossRefGoogle Scholar
  42. 42.
    DeRiso AJ 2nd, Ladowski JS, Dillon TA, Justice JW, Peterson AC (1996) Chlorhexidine gluconate 0.12 % oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 109: 1556–1561PubMedCrossRefGoogle Scholar
  43. 43.
    Segers P, Speekenbrink RG, Ubbink DT, van Ogtrop ML, de Mol BA (2006) Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA 296: 2460–2466PubMedCrossRefGoogle Scholar
  44. 44.
    Koeman M, van der Ven AJ, Hak E, et al (2006) Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med 173: 1348–1355PubMedCrossRefGoogle Scholar
  45. 45.
    Tantipong H, Morkchareonpong C, Jaiyindee S, Thamlikitkul V (2008) Randomized controlled trial and meta-analysis of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia. Infect Control Hosp Epidemiol 29: 131–136PubMedCrossRefGoogle Scholar
  46. 46.
    Fourrier F, Dubois D, Pronnier P, et al, PIRAD Study Group (2005) Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: a double-blind placebo-controlled multicenter study. Crit Care Med 33: 1728–1735PubMedCrossRefGoogle Scholar
  47. 47.
    Pileggi C, Bianco A, Flotta D, Nobile CG, Pavia M (2011) Prevention of ventilator-associated pneumonia, mortality and all intensive care unit acquired infections by topically applied antimicrobial or antiseptic agents: a meta-analysis of randomized controlled trials in intensive care units. Crit Care 15: R155PubMedCrossRefGoogle Scholar
  48. 48.
    Chan EY, Ruest A, Meade MO, Cook DJ (2007) Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ 334: 889PubMedCrossRefGoogle Scholar
  49. 49.
    Zanatta FB, Antoniazzi RP, Rösing CK (2007) The effect of 0.12 % chlorhexidine gluconate rinsing on previously plaque-free and plaque-covered surfaces: a randomized, controlled clinical trial. J Periodontol 78: 2127–2134PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • M. P. Wise
  • D. W. Williams

There are no affiliations available

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