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Can Dental Care Fight Pneumonia?

27 October 2016

Can Dental Care Fight Pneumonia?

Data from a national survey suggest that people who never get a checkup have almost twice the risk of bacterial pneumonia as those who see their dentists twice a year, according to Michelle Doll, MD, of Virginia Commonwealth University in Richmond.

The finding builds on previous research showing a link between dental care and pneumonia in critically ill patients, Doll told reporters at the annual IDWeek meeting. The meeting brings together four organizations that focus on infectious disease -- the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), and the Pediatric Infectious Diseases Society (PIDS).

But the analysis extends that research to a more general population, in which bacterial pneumonia is much less common, Doll told MedPage Today.

She added that the clinical message for physicians is to stress the need for good dental care during medical checkups, even though there is little they can do directly.

"What can you do today? Probably not a lot," she said. "But I think it would be good not to forget the teeth as part of the whole body and general wellness."

The study "reinforces" the need for comprehensive wellness care, commented Thomas File Jr., MD, chief of the Infectious Disease Service at Summa Health System in Akron, Ohio, who was not part of the study but moderated a media briefing at which some details were discussed.

Bacterial pneumonia is a serious illness "associated with significant morbidity and mortality," he said, adding, "Anything we can do to reduce the burden of disease is important."

File noted that aggressive approaches to reducing the bacterial burden in the mouth using chlorhexidine rinses or gels are now the standard of care when hospital inpatients are on a ventilator.

Doll said the link between bacteria in the mouth and pneumonia is fairly straightforward. After all, she said, there's a "direct conduit" between the mouth and the lungs, and it is easy to aspirate bacterial species that can cause disease.

To investigate the issue, she and her colleagues turned to the Medical Expenditure Panel Survey (MEPS), "a set of large-scale surveys of families and individuals, their medical providers, and employers across the U.S.," according to the Agency for Healthcare Research and Quality, which runs them.

With MEPS data from 2013, the researchers were able to assess participants' access to dental care -- the number of dental visits in 2013, the frequency of having dental checkups, and the presence of dental insurance -- and used ICD-9 codes to look for bacterial pneumonia in the previous year.

All told, the survey had data on 26,687 people, including 441 who had an episode of bacterial pneumonia.

The two groups had some significant differences, the analysis showed. Those who got pneumonia were:

  • More likely to be white and older, with an average age of 47 versus 40
  • More likely to have comorbidities and cognitive limitations
  • Less likely to have dental insurance

Importantly, just 34.2% of those who developed pneumonia reported having at least two dental checkups a year, compared with 45.9% of those who did not, Doll and colleagues found. Conversely, 29.4% of the pneumonia patients said they never got dental checkups, compared with 16.2% of the other participants.

Multivariate analysis showed that white race, increasing age, comorbidities, and worse perceived health status were associated with an increased risk of pneumonia. But the only dental variable associated with disease was the reported frequency of checkups, Doll said.

The analysis showed that those who reported never having checkups had an odds ratio for pneumonia of 1.86 compared with those who reported two or more checkups a year. Similarly, those who had some checkups but less often than once a year had an odds ratio for disease of 1.49.

Both findings were significant, with 95% confidence intervals of 1.30 to 2.65 and 1.02 to 2.16, respectively, Doll and colleagues reported.

Birth control: Male contraceptive injection 'shows promise'

A hormone injection has been shown to be a safe and effective method of contraception - for men.

US researchers say the jab was almost 96% effective in tests on around 270 men who were using it, with four pregnancies among their partners.

However, a relatively high number developed side effects, including acne and mood disorders.

Researchers have been investigating potential for male hormonal contraceptives for around 20 years.

They have all been looking for an effective way of suppressing sperm production without causing unpleasant or unbearable side effects.

Because men constantly produce sperm, high levels of hormones are needed to reduce levels from the normal sperm count of over 15 million per millilitre to under one million/ml.

This study was published in the Journal of Clinical Endocrinology & Metabolism, and published by the Endocrine Society.

It looked at men aged 18-45 who had been in monogamous relationships for at least a year - and whose partners had agreed to take part.

The men's sperm counts were checked at the beginning of the study, to ensure they were normal.

They then had two hormone injections (progesterone and a form of testosterone) every eight weeks, and were monitored for up to six months until their sperm count fell to under a million.

They were then asked to rely on the jab, which they continued to have at the same interval, as their only form of contraception during the efficacy stage of the study, which lasted for up to a year,

Once they stopped having the injections, they were monitored to see how quickly their sperm counts recovered.

Eight men had not recovered their normal sperm counts a year after the study ended.

Dr Mario Festin, of the World Health Organization (WHO) in Geneva, who carried out the study, said: "The study found it is possible to have a hormonal contraceptive for men that reduces the risk of unplanned pregnancies in the partners of men who use it."

The researchers stopped taking on new participants in 2011 after concerns were raised about side effects such as depression and other mood disorders, as well as muscle pain and acne.

Such side effects caused 20 men to drop out of the study and were reported by many others,

Doctors excited by cystic fibrosis therapy

A therapy that corrects the underlying cause of cystic fibrosis could transform treatment, doctors have said.

Only half of people with cystic fibrosis make it into their 40s.

Defects in their DNA mean they produce thick, sticky mucus that clogs and inexorably damages their lungs.

Data presented at the North American Cystic Fibrosis Conference shows that a drugs combination - which enables production of runnier mucus - slows the irreversible decline in lung function.

Errors in people's DNA - or genetic code - can lead to defective microscopic machinery in the lungs.

Instead of producing a normal protective layer of mucus, they get the balance of salt and water wrong and it becomes damaging.

Antibiotics help prevent infections settling in and drugs can loosen the mucus, but nothing deals with the fundamental problem for most patients.

Early studies had suggested the drugs lumacaftor and ivacaftor could alter the microscopic machinery so they made runnier mucus.

Those studies followed patients for just 24 weeks, but now doctors have nearly two years of data on them.

The drug combination is clearly not a cure, but the researchers said the untreated patients would expect their lung function to decline by 2.3% a year, but this fell to 1.3% in those given the therapy.

What do you think? Are you happy about less sugar in your food? Does this new contraception seem promising? Could this finally help those suffering with the disease? 

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