Hospitalization leads to deterioration in oral health. Critical Summary Prepared by: Catherine Hayes DMD, Dr.Med.Sc. 


  • Systematic Review Conclusion:

    Hospitalization is associated with a deterioration in oral health, particularly in intubated patients.

  • Critical Summary Assessment:

    Oral hygiene and gingival health deteriorate over 5-20 days of hospitalization.

  • Evidence Quality Rating:


A Critical Summary of:

The impact of hospitalization on oral health: a systematic review

Terezakis, E., Needleman, I., Kumar, N., Moles, D., Agudo, E.. Journal of Clinical Periodontology. 2011;38(7):628-36

  • Clinical Questions:

    What is the effect of hospitalization on oral health?

  • Review Methods:

    Two calibrated reviewers searched five databases without language restriction to locate longitudinal prospective observational studies in hospitalized individuals of all ages, except psychiatric or chemotherapy patients. Oral health outcomes included in the search were tooth loss, periodontal health, caries and stomatological diseases. To score quality, the authors used the Newcastle-Ottawa scale for cohort studies, excluding the comparison scores since no comparison groups were included in these studies.

  • Main Results:

    The authors identified five studies for review. They agreed that the study populations were representative, follow-up times adequate and outcomes adequately assessed albeit with surrogate measures, such as plaque accumulation and gingival health. Although it was impossible to assess differences in incidence of caries or periodontal disease given the short follow-up time, increases in plaque accumulation, gingival inflammation and mucositis were noted.

  • Conclusion:

    Hospitalization is associated with deterioration in oral health, particularly in intubated patients.

  • Source of funding:

    None stated.


  • Importance and Context:

    There are nearly 40 million hospital stays annually in the United States, with –adults over age 65 years hospitalized at a disproportionately higher rate than the younger population. Given that those over age 65 years are more likely to have compromised oral health than their younger counterparts and given their greater likelihood of being intubated than those younger counterparts, preventing deterioration in oral health among hospitalized patients is important. Ensuring adequate oral health among hospitalized patients is important for nutritional intake, prevention of infections and quality of life.

  • Strengths and Weaknesses of the Systematic Review:

    Calibrated reviewers carefully conducted this systematic review from five databases using comprehensive search criteria supplemented by hand searching of identified articles. No language restrictions were used and first authors of original reports were contacted for clarifications. This review included a detailed list of search strategies, study quality assessment, and validity of outcomes measures.

  • Strengths and Weaknesses of the Evidence:

    The majority of the studies were conducted in Intensive Care Units (ICUs) and therefore are not generalizable to all hospitalized patients. The follow-up period varied from 5-20 days limiting the oral outcomes that could be adequately assessed to oral hygiene status, gingival health and mucositis. Heterogeneity of oral care regimens and indices used to assess outcomes further limits the utility of the findings.

  • Implications for Dental Practice:

    This review suggests that oral health deteriorates with hospitalization, however oral health outcomes were limited to those that can be adequately assessed on a short-term basis such as gingival inflammation, plaque and mucositis. The effect of hospitalization in units other than ICUs, and not involving intubation, remains unknown. Thus, the generalizability of this review is limited.

  • Critical Summary Publication Date: 1/24/2012

These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association ©

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