Denture Wearing during Sleep Doubles the Risk of Pneumonia in the Very Elderly

T. Iinuma, Y. Arai, Y. Abe, M. Takayama, M. Fukumoto, Y. Fukui, T. Iwase, T. Takebayashi, N. Hirose, N. Gionhaku and K. Komiyama

J DENT RES 7 October 2014

Abstract: Poor oral health and hygiene are increasingly recognized as major risk factors for pneumonia among the elderly. To identify modifiable oral health–related risk factors, the authors prospectively investigated associations between a constellation of oral health behaviors and incident pneumonia in the community-living very elderly (i.e., 85 years of age or older).

At baseline, 524 randomly selected seniors (228 men and 296 women; mean age, 87.8 years) were examined for oral health status and oral hygiene behaviors as well as medical assessment, including blood chemistry analysis, and followed up annually until first hospitalization for or death from pneumonia. During a 3-year follow-up period, 48 events associated with pneumonia (20 deaths and 28 acute hospitalizations) were identified.

Among 453 denture wearers, 186 (40.8%) who wore their dentures during sleep were at higher risk for pneumonia than those who removed their dentures at night (log rank P = 0.021). In a multivariate Cox model, both perceived swallowing difficulties and overnight denture wearing were independently associated with an approximately 2.3-fold higher risk of the incidence of pneumonia (for perceived swallowing difficulties, hazard ratio [HR], 2.31; and 95% confidence inter- val [CI], 1.11–4.82; and for denture wearing during sleep, HR, 2.38; and 95% CI, 1.25–4.56), which was comparable with the HR attributable to cognitive impairment (HR, 2.15; 95% CI, 1.06–4.34), history of stroke (HR, 2.46; 95% CI, 1.13–5.35), and respiratory disease (HR, 2.25; 95% CI, 1.20– 4.23).

In addition, those who wore dentures during sleep were more likely to have tongue and denture plaque, gum inflammation, positive culture for Candida albicans, and higher levels of circulating interleukin-6 as compared with their counterparts. This study provided empirical evidence that denture wearing during sleep is associated not only with oral inflammatory and microbial burden but also with incident pneumonia, suggesting potential implications of

Discussion: We have long known that wearing dentures 24/7 was not a good thing, and we have all been telling our patients to leave their dentures out at night. Before this study was done, I think as dentists we were mostly concerned with the oral inflammation and abused residual ridges or our patients. I know many patients despite our recommendations will refuse to take their dentures out at night.

Do you discuss the risk of pneumonia and increased bio-burden with your patients? Do you wonder if these findings translate to patients with non-removable acrylic supported on implants? More research is indicated, but it is clear that patients with removable prostheses should not be sleeping with their dentures in for several good reasons.