It has been known for centuries that dental health and systemic health are linked. However within the challenging environment of a hospital, oral care is still, quite often a low priority. Recent studies reveal that total bacterial count of dental plaque increases during hospitalisation and the oral cavity of hospitalised patients can harbour high frequencies of bacterial respiratory pathogens. As a result, this can lead to infections and hospital acquired pneumonia (HAP)2.
As well as inadequate oral hygiene, the potential risks to oral disease and discomfort in hospitalised patients include a significant number of medications as well as artificial feeding and high-calorie food supplements used to maintain nutrition. In addition, the effects of nasal oxygen, mouth breathing, intermittent suction of the airway and the restriction of oral food and fluid all contribute to a decrease in saliva production and symptoms such as xerostomia.
Another common problem for sick patients is the dry mouth and discomfort caused by constant open mouth posture that is required for intubation. For those undergoing surgery, there can also be further complications. A study involving 404 surgical patients under general anaesthesia facilitated by endotracheal intubation, revealed that 6.9% sustained various degrees of oral trauma including soft tissue laceration, tooth fracture, prosthesis damage, tooth avulsion, ecchymosis and numbness of tongue. In addition, a recently published study on the oral health of 162 patients found an increase in plaque levels and deterioration of gingival health during just a short stay in hospital.
If a patient that has recently been hospitalised attends the dental practice, practitioners may observe oral tissue and tooth trauma, high plaque levels, gingivitis and periodontal disease. As always, it is fundamentally important to reinforce oral health instructions and to treat any dental problems efficiently. If, for example, periodontal disease has developed, it is first necessary to remove and disrupt the plaque using root surface debridement (RSD). In cases with deep periodontal pockets it is usually necessary to implement an adjunctive therapy to inhibit further periodontopathic bacterial growth and allow the periodontium time to heal and stabilise. Some practitioners use antibiotics for this purpose, but, if the patient has recently been unwell and had antibiotics prescribed previously, the risks of resistance are greater and it is preferable to use an antimicrobial alternative.
Practitioners should therefore consider PerioChip® – a wafer thin dental insert that is an effective, non-antibiotic alternative for treating periodontal pockets over 5mm. PerioChip® is applied directly into the periodontal pocket and slowly releases chlorhexidine digluconate to eliminate 99% of bacteria over 7-10 days. Furthermore, the insert employs a controlled-release system and continues to provide an antibacterial effect to suppress bacterial growth for up to 11 weeks after placement.
As it seems that care for medical and dental problems are still less coordinated than we might expect, it is imperative to emphasise to patients that successful recovery after a period of ill health or hospitalisation is not just about the body but also their oral health.
 Sachdev M, Ready D, et al. Changes in dental plaque following hospitalisation in a critical care unit: an observational study. Crit Care. 2013 Sep 4;17(5):R189. doi: 10.1186/cc12878. http://www.ncbi.nlm.nih.gov/pubmed/24007571 [Accessed 1st September 2015]
3 David Zuanazzia, Renata Soutoa, et al. Prevalence of potential bacterial respiratory pathogens in the oral cavity of hospitalised individuals. Archives of Oral Biology Volume 55, Issue 1, January 2010. doi:10.1016/j.archoralbio.2009.10.005 http://www.sciencedirect.com/science/article/pii/S0003996909002581 [Accessed 1st September 2015]
 Janet Griffiths and Debbie Lewis. Guidelines for the oral care of patients who are dependent, dysphagic or critically ill. Journal of Disability and Oral Health (2002) 3/1 30-33. http://www.shancocksltd.co.uk/download.php?op=view_article&article_id=57 [Accessed 1st September 2015]
 Fung BK, Chan MY. Incidence of oral tissue trauma after the administration of general anesthesia. Acta Anaesthesiol Sin. 2001 Dec;39(4):163-7. http://www.ncbi.nlm.nih.gov/pubmed/11840582 [Accessed 1st September 2015
 Lucas L. A. Sousa, Wagner L. S. E. Silva Filho, et al. Oral health of patients under short hospitalization period: observational study. Journal of Clinical Periodontology 2014; 41: 558–563. doi:10.1111/jcpe.12250. http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12250/abstract [Accessed 1st September 2015]
 Jeffcoat M K et al. Adjunctive use of a subgingival controlled-release chlorhexidine chip. J Periodontal 1998; 69 (9): 989 – 997. http://www.ncbi.nlm.nih.gov/pubmed/9776027 [Accessed 1st September 2015]
 http://www.old.health.gov.il/units/pharmacy/trufot/alonim/PerioChip_dr_1337488974840.pdf [Accessed 1st September 2015]