The underappreciated toothbrush

Also: Mass. scrambles to keep Steward hospitals afloat [Donate ❤️]( [View in Browser](  January 23, 2024 Hi CommonHealth reader, Until recently, I’d never thought of toothbrushing as a life-saving routine. But now, I do.  A study, published last month in [JAMA Internal Medicine]( found the simple act of brushing one’s teeth could have a dramatic impact on pneumonia rates — and death rates — among certain patients. The researchers analyzed the results of 15 studies, encompassing more than 2,700 patients. Most of the patients were on ventilators and in intensive care units. They were randomly assigned to either have their teeth brushed, or not. The outcomes for those lucky enough to be in the toothbrushing group were eye-catching. Their risk of pneumonia dropped by about a third. They shaved nearly two days off their stays in the ICU. And, perhaps most dramatic, their mortality rate was almost 20% lower. “Wow, that’s a lot,” Michael Klompas remembered thinking when he first saw all the differences in outcomes. “We were surprised.” Klompas is co-author of the study, and an infectious disease physician and hospital epidemiologist at Brigham and Women's Hospital. “To find something that's simple, that's common, that's cheap and that’s so effective is pretty amazing,” he told me. The reason toothbrushing seems to be so important is because it reduces the bacteria in your mouth. If you have lots of bacteria in your mouth, it can get into the lungs and cause pneumonia. “It's under-appreciated, but pneumonia is probably the most common hospital-acquired infection,” Klompas said. “And it has a very high mortality rate for those who get it.” To those in the dental world, none of this is news — but there is a lingering mystery. “We've known about this for a long time,” explained Thomas Van Dyke, of the Harvard Dental School and the American Dental Association’s Forsyth Institute. For over a decade, he said, dentists have known toothbrushing is particularly important for frail and older patients. (That comes from data from nursing homes.) But what has both Van Dyke and Klompas somewhat baffled is why toothbrushing is not part of every hospital’s ICU oral care plan. “I'd say right now, maybe about two-thirds of hospitals, from what data I've been able to see, include toothbrushing,” he said. “So there is room to grow over there.” Van Dyke attributes part of the problem to how siloed dentistry is from other types of medical care. He thinks nurse shortages and logistical challenges might also be a factor. “The problem is, from the point of view of the health care facility, it's an extra procedure. And it takes somebody some time to do this every day,” he said. Whatever the reason, Van Dyke said it may be up to insurance companies to insist that hospitals change their oral care policies to fully embrace toothbrushing. After all, they are the ones footing most of the bill for pneumonia care, meaning they have the potential to see the most savings from less time spent in the ICU. 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