Periodontal Diseases

A Q&A With Rupak Datta < Yale School of Medicine


Rupak Datta, MD, PhD, MPH, is an Assistant Professor of Medicine (Infectious Diseases) at Yale School of Medicine (YSM) and an Assistant Hospital Epidemiologist at the Connecticut Department of Veterans Affairs Healthcare System. His research focuses on improving clinical outcomes and reducing adverse events in older adults through antimicrobial stewardship.

In his recent comments Journal of the American Medical Association Internal MedicineDatta writes that daily brushing is a strategy for preventing hospital-acquired pneumonia. Below, he discusses the connection between oral care and health.

How did you realize the connection between oral care and overall health?

I learned about the connection between oral care and health through the Infectious Diseases Fellowship at YSM. Patients with poor oral hygiene are prone to invasive infections such as bloodstream infections and endocarditis. As an infectious disease researcher, I learned that periodontal disease is a key risk factor for infection. My interactions with surgeons and dental professionals reinforced this idea. For example, oral care is often required before complex cardiothoracic surgeries.

Tell us more about the science behind this link.

The oral cavity is a vast reservoir of many microorganisms, such as bacteria, fungi, and protozoa. If a malfunction occurs, many microorganisms, especially bacteria, may enter the bloodstream or local tissues, especially in individuals with weakened immune systems. Brushing and other mechanisms that promote oral health can reduce the burden on these microorganisms.

Brushing your teeth removes plaque, or biofilm, where microorganisms are prevalent. When plaque builds up, bacteria can invade the mouth, respiratory tract, bloodstream, and even heart valves or other places. Mechanisms that reduce biofilm, such as brushing teeth, have been shown to be effective in reducing infection.

What have you learned through recent research in this area?

A recent meta-analysis suggests that brushing your teeth may reduce the risk of hospital-acquired pneumonia. Prior to this meta-analysis, research had focused primarily on chlorhexidine, which is used as an antibacterial mouthwash. The idea is that if we can use this mouthwash to reduce biofilm and microbial burden in the mouth, we can minimize pneumonia. But the evidence on this is mixed.

Brushing your teeth is a different way to mechanically remove these biofilms. There is growing evidence that brushing teeth is particularly effective in reducing pneumonia in patients on mechanical ventilators.

What can the average person take away from this study?

Regular brushing removes harmful bacteria, reduces the risk of oral infections like gingivitis and periodontal disease, and more importantly, reduces serious infections like pneumonia, blood infections, and endocarditis. Good oral hygiene is a simple yet effective tool in preventing infection and may be similar to hand hygiene. As a result, we might start treating toothbrushing like handwashing—both important infection prevention measures.

The Division of Infectious Diseases in the Department of Internal Medicine at Yale School of Medicine is dedicated to comprehensive and innovative patient care, research, and education activities across a broad spectrum of infectious diseases.For more information, please visit infectious diseases.

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