Colonizacion Del Biofilm Protesico en Vias Aereas

8/7/2019 Colonizacion Del Biofilm Protesico en Vias Aereas

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Colonization of denture plaque by respiratorypathogens in dependent elderly\ Sumi', H IVliura^ M Suniikawa\ Y MichiwakM and N Sakagami''n i i v c l m . Depar tment of Dental S i n j j c i y . Th e Niilioiial Cluiliu l l n s p i t a l . Oh u C i t y . J a p a n ; I ' lDlcssor. I i rpur tmcnl nl S p i c c h ' f h c r a p y ,.SLIU ml of Heal th .ScK ' iKe. Kyiisliu University of Health and Wei I a r e . N d l i e o k a , J a p a n . 'AssoeMlc I ' lnressur. ('leanriHirii. I l i i iversity Hdsfiitaf

haeul t\ ol D e n t i s t r y . Tokyo Medieal and Dental L l n i \ e r s i l y . l o k y o . J a p a n . 'A s s m . i.iii.- Prulessor. d e p a r t m e n t ul Oral .m d Ma\ i l l ( i rae i a lS i i r g e i ) . Sehool ol D e n t i s t r y . Sl iou: i L'nlversity. T o k y o . J a p a n ; \SRI , Inc . K;in,iL'.i\\a J a p a n .

AbstractObjectives: Reeently, there has been a resurgenee of interest in the interaetions between oral eonditionsand a number of prevalent systemie diseases. The morbidity and mortality of the dependent elderly thatresult from aspiration pneumonia have been reeogni/ed as a major geriatrie health problem. 1 he purposeof this study was to gain more infomiation on the tnieroflora of plaque on dentures and to assess theexistenee of oral infeetious pathogens potentially eausing the respiratory disease in the dependent elderly.Subjects and Methods: The denture baeterial flora of 50 dependent elderly were examined to identif>mieroorganisms by the culture method. Results: IS speeies of mierootganisms were deteeted in dentureptaque in this study. A \ ariety of pathogens w ith the potential to cause respirator) infection pathogenscolonized on the dentures of dependent elderly. Conclusion: The results of the present study revealed thatbacteria that commonly cause respiratory infection colonized on the dentures of dependent elderly,suggesting that denture plaque may funetion as a reservoir of potential respiratory pathogens to facilitatecolonization on the oropharynx.

Key words: denture placpie, dependent elderlv, aspiration pneumonia, hen le rial flora

IntroductionIn a number of societies, the proportion who areelderly is steadily increasing. Japan faces aglobally unprecedented future as an aging society.It is widely acknowledged, both in and outsidegovernment, that by 2020 more than one in fourJapanese will be over 65'. It is known that theprevalence of denture wearing increases with age\and that most denture-wearing patients, especiallydependent elderly, do not keep their prosthesesclean \

Pneumonia can be a life-threatening infection,especially in the elderly, and it is a significant cause

respiratory pathogens. Oral bacteria can be releasedfrom the denture plaque into the sali\ ar\ secretionswhich are then aspirated into the lov\er tespiratorytract to cause pneumonia. Several studies havereported that denture plaque may be a source ofrespiratory pathogens^'' . Howe\ei, few studieshave investigated whether respiratory pathogenscolonize the denture plaque of dependent elderlydespite the facts that: (I) the oral hygiene ofdependent elderly individuals is extremely poor',(2) the tiiortality and morbiditv of pneumonia in


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\ \ S i m i i . I I M i n i . I , M S i i i i . i k . i w . i . ^ M l , l i i w . i k i . i i i i l N , S : i k ; i ) j : m i i

p r e s e n c e m a h s c i K e ol l e s p i i a l n i y p a l l i o g e n uhai.li.-i 1.1 in the d e n t n i e p l a q u e I IK - p u r p o s e ol t h i ss tudv was lo d e l e i n i i n e il p o t e n t i a l l e s p i i a t o i yp a t h o g e n s c o U M i i / e the d e n t u r e p l a q u e o\d e p e n d e n t e l d e r l vM a t o i i a i s and i n e l h o d s/ . Siihui Isl i t t v p a t i en t s of the D e p a r t m e n t of Denta l .Su igeryo l N a t i o n a l C l u i b u H o s p i t a l p a r t i e i p a t ed in t h i ssu idv Ihev eon s i s t e i l ol .^0 d e p e n d e n t e l d e r l y (24wiMiien and 2(^men, age r a n g e : dO S') y e a r s old;m e a n age: 74.^) + 9.7) who w e a r m a x i l l a r ye o m p l e t e d e n t u r e s and r eq u i r e o r a l e a r e hv t h e i re a r e g i v e r s . The s t u d y p o p u l a t i o n s a t i s f i e d thef o l l o w i n g r e q u i r e m e n t s for i n e l u s i o n w i t h i n t h i sp ro j ee t : (a) the a b s e n e e ol ae t i v e o r a l d i s ea s e , (b)no h i s to rv ot a n t i m i e r o b i a l t h e r a p y w i t h i n thep r e v i o u s e i g h t w e e k s , and (e) no h i s t o r y ofd i a b e t e s . .Ml d e n t u r e s w e r e f u n e t i o n a l , and hadb e e n w o r n for at l eas t two y e a r s and a m a x i m u mof IS y e a r s . .Ml p a t i e n t s s h o w e d p l a q u e on thef i t t ing surfaee of t h e ir m a \ i l l a i \ e o m p l e t e d e n t u r e s .: . McthnJsThe denture surfaee w as first earefully dried by asteri le gauze to avoid eon tamina t ion by saliva.Denture plaque from the fitting surfaee of upperfull dentures was aibbed with No. 1 Seed .Swab(Eiken Kagaku.Tokvo Japan) toeolleet speeimens,whieh were then eheeked for mieroorgan isms byt h e e u l tu r e m e th o d . .All o ra l m ie ro b io lo g ie a lsampling w as eondueted by a single examiner. The

s a m p l e was i m m e d i a t e l y t r a n s p o r t e d to thelaboratory. .Speeimens were inoeulated onto 5peieent sheep's blood agar plates, elioeolate agarplates, MaeConkey agar (I ikeii Kagaku, Tokyol a p a n i , OPA a g a r p l a t e s ( N i p p o n B e e k t o nDiekiiisoM, Tokyo Jap an) , C'HROM aga r eandi da( K a n t o K a g a k u , T o k yo J a p a n ) for a e r o b i eo rg a n i sm s , e sp e e i a l l y re sp i r a to ry p a th o g e n icbaeteria . The prevalence of potential respiratorypa thogens was determined by eulture. The plateswere ineuba ted at 35"+ 2' for 4S hours underaerob ic condi t ions , and representat ive eoloniesi s o l a t e d w e r e s u b e u l t u r e d and i d e n t i f i e d bystandard methods '" . In this study, subjects wereconsidered coloni/ed with respiratory pathogensonly il Staphyhu ( X i I I S aurciis, StrcpldCdccnspncumonicic, Psciulnmoncis aeriiginosa,Hacmophiliis infliwiKoc, Haemophiluspaiainjluciizae, Enlcroluuter cloacae. KIchsicllapneiimoniac, Scrratia maiccsccns, Proteusmirahilis or lisi Iwru hia coli were isolated fromany denture sample.'"'-Results/ . Microflora of denture plaque of dependentelderlyAerobie baeteria were isolated in 50 patients. Thedeteetion rates of aerobie organisms of dentureplaque are summarized in Figure 1. Thepredominant aerobie organisms on dentures wereSiirptococcus spp. (deteetion rate: 987r), Candidaspp. (S()^ ) and Neisscria spp. i M ^ ' < ).

Microflora of denture plaque of dependent elderly\t refill I , I K i ti\ spp.

(. iinJidii spp\ei\\ena spp.

hnltnihacter spp.Kleh\iella spp,

L < ' r \ nthi.il { < riunt spp.Staphyhn ot iusspp.

f'seiuiuiniinas spp.Al tnetxhui ter spp.

/: s< hern hiu colil.titcri't III I us s p p .

Hanllu.s spp\ ! u ii'i "I t {t\ s p p

itti'lnu tl r spp,


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nii of ik'iiliiu- |il.ii|iii' by p;illi(i).'iMs In dependent cMcrly 27

2. l\(\\i>irttlor\'A \ ; i i i e t y ol p o t e n t i a l r c s p i i a l o i y p a l h o j i c n sc o l o n i / o t i the o r a l ( . a v i t i c s ol the d e n t u i c old e p e i u l c n t CKICIIN ( F i g u r e 2 ) . T h e p r e d o m i n a n tp o t e n l i a l r e s p i r a to r y p a t h o g e n s d c t c c l e d ond e n t u r e s w e r e Inicrohacier cloacae ( I S ' < ).Kleh.\iclla pneiinioniite ( I d ' < ), and .Siai>liyloc(i((ii.\aiireus ( I O ' < ) . No Hacmophilus influen:ite.Serralia nuiices( (iis, Proteus mirahilis orSneptociH ciis pncuinoniae wo r e d e t e c t e d indenture plaque.

In 23 cases out of 50 (46' i ), potential respirato rypalhogens colonized in the denture plaque.Discussion1. Microflora of denture plaque of dependentelderlvThe oral cavity harbours acomplex microbiota .wi th >300 iden t i f ied (and p robab ly a s im i l a rn u m b e r of unnamed) spec ies of bacteria so farisolated. These bacteria form complex, but well-ordered structures referred to as dental plaque onthe teeth, and also as denture plaque on the dentu res u r f a c e s ' " . T h e i l a d e etal. r e p o r t e d t h a t themicroflora of denture plaque is highly variable, andto a large extent similar to that of some forms ofden ta l p laque , where s t rep tococc i , facu l ta t iveactinomyces. and in some cases also lactobacilli .p redomina te" . Car l s son ei at . demonstrated thatStreptococcus mutans an d Streptococcus sangiiisw ere prominent members of the flora on dentures''*.The results ot the present study demonstrated thatthe predominant aerobic organisms on dentureswere Sirepiococcii.\ spp. (detection rate: ')S'^7f),

Candida s|)p. (8()'/^ ) an d Netssciiit spp .CoullcT et al. '' icporlL'd that thedenture couldinduce an increase in pathogens SIK li as Neissci las|i|i. c l c , u h n. h IS sii|ipoi'liVL' ol the results in thep iL 'sen t s tudy . Int h i s s t u d y , ISs p e c i e s ofinieniorganisiiis were delected in denture plaque,among the mosi numerous ni imbeis mentioned inpre\ious reports. Lack o( attention looral hygieneresults inan increase in the mass and complexityo f d e n t u r e p l a q u e , w h i e h may lOs te r anenvironment that promotes eoloni/a l ion by manyorganisms. Since functionally-impaired elderlypatients often reeei\ e poor oral care, they may havedenture bacterial colonization with aerobie flora.The results of this study were slightly differentfrom those of former reports. Further studies areneeded loe l a n ly thedifference in the detectedspeeies .

Previous microbiological s tudies have mainlyconcentrated on the presence and possible role ofyeasis in denture-induced s tomati t is" ''. Gusbert iet al. reported that Candida albicans representedonly aminor part of the total cultivab le flo ra' \Ho wev er, our results show ed that Candida spp . isone of the most predominant organisms. Thesefindings suggested that the denture plaque on thedependent elderly might be different from that ota healthy patient or the tlora m ight ha\ e chan gedwithin 25 years beeause of the use ofman\ drugsinc lud ing an t ib io t ics . When thep la q u e is leftundisturbed, there will be an increase in Candidaspp. colonization. Therefore, poor denture hygienemay also be respons ib le for the high levels ofCandida spp. found in this stud\.

Detection rates of potential respiratory pathogens on denturesU t clo

l l>lhlllllnllltlr

Sla/'livldi I'l I ii\ MRS\4'WMSS\6'i

/: \i Ihih hklt.oh

Hiiiiiiii[>/iili(\ parainflui'Hzue 4 ' f


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'S h Sniu i. II Mini.I. M Siinak awa, N Mulilwaki tiiul N .Sakiij-aini

J. PicM iiiC of ju^tcntiiil respiriitory pitthoi^ens ondciiliiicbacterial pnetimonia in ailtilts is the result ofaspiration of oropluuvtigeal llora into the lowerrespiratory tract and failure of host defencemechanis ius to e l iminate the contaminat ingbacte ria, which nuiltip l\ in the lung and causeinfection. Respiratorv pathogens are not usuallyprominent members of the oral indigenous floraof health) adults'. Because coloni/ation of thepharyngeal nuieosa by respiratory pathogens isthought to be a transient phen omeimn, it is possiblethat respiratiM V pathogens could originate from theoral ca\it\ . Recent studies have suggested thatdental plaque is a potential reservoir for respiratoryinfection'**-' .\n inc rease in potential respirato rypathogens in the oral cavity has thus beencon side red a high risk factor for asp iratio npneumonia. Russell et al. reported the prevalenceand distribution patterns of suspected respiratorypathogen s in the dental plaque of older indi\ idualsliving in a long-term care facility'. Few studieshave reported the possibility of denture plaque asa source of respiratory pathogens. The possibilitythat denture bacterial plaque might be involvedduring the sequence of initial colonization and mayrepresen t a specific source of no.socomial infectionhas been poorly examined. The present studyevaluated the prevalence of potential respiratorypathogens tn the denture plaque of dependentelderly.

The results of this study detected potentialrespiratory pathogens with a high frequeney indenture plaque samples. Denture plaque maytherefore prov ide a reserv oir for respirato rypathogen c olonization that can be shed into saliva.These results also indicated that dependent elderly,who are at greater risk for lower respiratoryinfection, have a greater tendency for their dentureplaque to be colonized by respiratory pathogens.It is suggested that the denture plaque mayconstitute an additional, possibly more stable,reservoir of respiratory pathog ens. Oral he althca refor elderly patients in nursing homes reducesbacterial pneumonia-', and denture plaque controlis essen tial for the preven tion of ba cterialpneumonia.

We conclude from our study that denture plaquemust be con side red a specific r eserv oir of

oral health of the denture patient, the importanceof plaque removal from a denture cannot beoveremphasized.

References1. Arai Y, Ikegami N. How will Japan copewith the impending surge of dementia? In: HealthEconomics of Dementia, eds. W imo, A. Jonsson,B. Karlson, G. W inblad, A. Chichester: John Wiley&Sons, 1998: 275-24.2. Fure S, Zickert I. Salivary conditions andcariogenic microorganisms in 55, 65 , and 75-year-old Swedish individuals. Scand J Dent Res 1990;98 : 197-210.3. Pietrokovski J. Oral findings in elderlynursing home residents in selected countries: Oralhygiene conditions and plaque accumulation ondenture surfaces. J Prosth Dent 1995; 73: 136-1414. Scannapieco A F. Relationships betweenperiodontal disease and bacterial pneumonia. JPeriodontol 1996; 67: 1114-1122.5. Verghese A, Berk S L. Bacterial pneumoniain the elderly. Medicine 1983; 62 : 271-285.6. Scannapieco A F, Stewart M E, Mylotte MJ. Colonization of dental plaque by respiratorypathogens in medical intensive care patients. CritCare Med 1992; 20: 740-74 5.7. Russell L S, Boylan J R, Kaslick S R, etal. Respiratory pathogen colonization of the dentalplaque of institutionalized elders. Spec Care Den1999; 19: 128-134.8. Fourrier F, Duvivier B, B outigny H,etal.Colon izat ion of denta l p laque: A source ofnosocomial infections in intensive care unitpatients. Crit Care Med 1998; 26: 301-3 08.9. Abe S, Ishihara K, Okuda K. Prevalenceof potential respiratory pathogens in the mouthsof elderly patients and effects of professional oralcare. Arch Gerontol Geriatr 2001; 32: 45-55.10 Murray R G E, Brenner D J, Bryant MP, et al. Bergeys Manual of Systematic


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' Colonizutiiin of denlurc plaque by rcspiiiilory in dLpcnclcnl elderly 2')

12. Bartlett J G. Gorbach S L. Finegold SM. The bacteriology of aspiialion pneumonia. AmJ Med 1974; 56: 202 -207.13. Theilade E, Budtz-Jorgensen K, TheiladcJ. Predominant cultivable microtiora of plaque onremovable dentures in patients with healthy oralnuicosa. Arch O ral Biol 1983; 28: 675-674.14. Carlsson J, Soderhohn G, Almfeldt I.Prevalence of Streptococcus sani^uis andStreptococcus mutans in the mouth of per.sonswearing full-dentures. Arch Oral Biol 1969; 14:243-249.15. Coulter W A, Strawbridge J L, CliffordT. Denture indueed changes in palatal microflora.Microb Ecol Health Dis 1990; 3 : 77-85.16. Davenport J C. The oral distribution ofCandida in denture stomatitis. BrDentJ 1970; 129:151-156.17. Budtz-Jorgensen E. The significance ofCandida albicans in denture stomatitis. Scand JDent Res \914;S2: 151-190.18. Gusberti F A, Gada T G, Lang N P. et al.Cultivable microflora of plaque from full denturebases and adjacent palatal mucosa. J Biol Bucc1985; 13:227-236.19. Garibaldi R A, Brodine S, Matsumiya S.Infections among patients in nursing homes:policies, prevalence, problems. New Eng J Med1981; 305:731-735 .

20. Scannapleco F A, Fanandonalos G D,Dunford R G. Associ i i t ions hclwccn ora lconditions and respiratory disease in a national.sample survey population. Ann Periodontol 1998;1: 251-256,21. Yoneyamu T, Hashimoto K, F^ukuda H .et al. Oral hygiene reduces respiratory infectionsin elderly bed-bound nursing hom e patien ts. /4r(/;vGerontol Geriatr 1996; 22: 11-19.

AcknowledgementThis research was supported in part by HealthSc iences Resea rch Gran t s (Comprehens iveResearch on Aging and Health 12-21) from theMinistry of Health, Labour and Welfare, Japan

Address for Correspondence:Yasunori Sum i, D.D.S., Ph.D.Director, Division of Dental Surgery,The National Chubu Hospital36-3, Gengo, Morioka, Obu City 474-8511,JapanBusiness Phone: -1-81-562-46-2311 ext. 731Fax Number: -1-81-562-44-8518e-mail address: [email protected]


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Colonizacion Del Biofilm Protesico en Vias Aereas