Factors associated with dental status among chronic mechanically ventilated patients

Objectives: The population of patients in need of chronic mechanical ventilation is growing. Many are fed via nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG). Maintaining oral hygiene is crucial since it may decrease the risk of ventilator-associated pneumonia. The aims of this study are to describe the dental and periodontal status of patients on chronic mechanical ventilation and to explore factors affecting this status, including the method of feeding. We hypothesized that oral health would be best in patients fed orally and worst in those fed via NGT.
Methods: All adults hospitalized in "Herzog Hospital" on chronic mechanical ventilation underwent oral examination to determine the number of teeth, and the number of decayed, missing, and filled teeth (DMFT Index), and the worst Community Periodontal Index (CPI) among examined sextants. Patient age, gender, method of feeding, BMI, duration of ventilation, reason for ventilation, cognitive status, medications, and presence/absence of diabetes were recorded.
Results: 92 patients, 51 males and 41 females, median age 74 years (range 21–97), median duration of ventilation 679 days, were examined. Mean number of teeth was 10.6, 39 patients were edentulous. Mean D score was 1.51; mean F score was 2.94. 27/50 patients in whom CPI score was assessed had a worst score of 4. No association was found between method of feeding (oral, NGT, PEG) and dental and periodontal status. On multivariate analysis, number of teeth was associated with age (β= -0.628, p< 0.001) and diabetes (β= -0.163, p=0.044), and periodontal status was associated with age (p=0.017).
Conclusions: Among patients on chronic mechanical ventilation, age and diabetes predict tooth loss and increasing age predicts periodontal disease. Contrary to our hypothesis, no association was found between method of feeding and oral health.