COPD exacerbation which increases morbidity and mortality is an acute event characterized by the worsening of respiratory symptoms.
COPD are prone to frequent exacerbations which are caused by infections. Frequent exacerbations are associated with a poor quality of life and result in increased hospitalizations and increased mortality. Patients with frequent exacerbations and increased airway inflammation, decreased lung function.
Several studies reveal that periodontal infections may be an increasing factor in systemic disease including pulmonary disease. Because of the relationship between the trachea and the oral cavity, there is a significant relationship between oral pathogens and exacerbation of COPD.
The inhalation of oral pathogens present in dental plaque is associated with an increased incidence of respiratory infections especially pneumonia and lung abscesses. In previous studies, it has been noted that oral interventions that reduce the amount of plaque seem to reduce the incidence of these infections. There are four mechanisms that would explain this relationship between periodontal disease and exacerbation of COPD:
- Aspiration of oral pathogens leading to pneumonia
- Periodontal-associated enzymes in the saliva which modify the epithelial surfaces promoting the accumulation of bacteria on the lung surface.
- Enzymes associated with periodontal disease may destroy protective salivary pellicles
- Immune substances called cytokineswhich may lower the respiratory epithelium resistance to infections.
In any event, this study in which the patients received scaling and oral hygiene instruction showed significant diminishing of the incidence of acute exacerbation resulting in medical visits and/or hospitalizations. There was a tendency for a return to more frequent bouts of infection as the periods between clinical treatments increased. Subsequently, without careful follow-up, increased oral hygiene instruction and/or continued debridement, there was going to be a reinfection vis-à-vis the increased instances of periodontitis.
The take-aways are as follows:
- Patients with COPD must be treated aggressively periodontally
- Frequency of their recalls should be increased to decrease the oral bacterial flora.
- Oral hygiene is critical and the use of chlorhexidine may be important in these patients
Click here to print a copy of this article