Oral Biofilms, Systemic Disease, and Pneumonia

Abstract

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.