Systematic Review of the Association Between Respiratory Diseases and Oral Health

Background: The purpose of this review was to investigate evidence for a possible etiological association between oral health and pneumonia or other respiratory diseases. Methods: The following data sources were used: Ovid MEDLINE (In‐Process & Other Non‐Indexed Citations, Daily Update, and OLDMEDLINE); Cumulative Index to Nursing & Allied Health Literature; Evidence Based Medicine of Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Database of s of Reviews of Effects; EMBASE; Health and Psychosocial Instruments; HealthSTAR; International Pharmaceutical s; PubMed; and Google Scholar from the earliest record until July 2005. Studies were selected from randomized controlled clinical trials and longitudinal, cohort, case‐control, and epidemiological studies. Searches were limited to English language and human studies. Results: A total of 728 articles were searched for relevancy, determined by article title, , and full copy, resulting in a yield of 19 studies that met our inclusion criteria. These articles were read and scored independently by the reviewers to obtain the evidence for this review: 1) the potential risk factors for pneumonia were identified as the presence of cariogenic and periodontal pathogens, dental decay, and poor oral hygiene in five studies; 2) a weak association between periodontal disease and chronic obstructive pulmonary disease (COPD) was identified in four poor to fair studies; and 3) 10 studies were retained providing evidence that interventions aiming to improve oral health reduced the progression or occurrence of pneumonia. Conclusions: 1) There is fair evidence (II‐2, grade B recommendation) of an association of pneumonia with oral health (odds ratio [OR] = 1.2 to 9.6 depending on oral health indicators). 2) There is poor evidence of a weak association (OR