beatdiabetesforever

Maybe we should add toothbrushes to the bouquet of flowers we bring to friends and family members in the hospital — and make sure to pack one if we wind up there ourselves.

New Harvard-led research published online in JAMA Internal Medicine suggests seriously ill hospitalized patients are far less likely to develop hospital-acquired pneumonia if their teeth are brushed twice daily. They also need ventilators for less time, are able to leave the intensive care unit (ICU) more quickly, and are less likely to die in the ICU than patients without a similar toothbrushing regimen.

Why would toothbrushing make any difference?

“It makes sense that toothbrushing removes the bacteria that can lead to so many bad outcomes,” says Dr. Tien Jiang, an instructor in oral health policy and epidemiology at Harvard School of Dental Medicine, who wasn’t involved in the new research. “Plaque on teeth is so sticky that rinsing alone can’t effectively dislodge the bacteria. Only toothbrushing can.”

Pneumonia consistently falls among the leading infections patients develop while hospitalized. According to the Agency for Healthcare Research and Quality, each year more than 633,000 Americans who go to the hospital for other health issues wind up getting pneumonia. Air sacs (alveoli) in one or both lungs fill with fluid or pus, causing coughing, fever, chills, and trouble breathing. Nearly 8% of those who develop hospital-acquired pneumonia die from it.

How was the study done?

The researchers reviewed 15 randomized trials encompassing nearly 2,800 patients. All of the studies compared outcomes among seriously ill hospitalized patients who had daily toothbrushing to those who did not.

• 14 of the studies were conducted in ICUs
• 13 involved patients who needed to be on a ventilator
• 11 used an antiseptic rinse called chlorhexidine gluconate for all patients: those who underwent toothbrushing and those who didn’t.

What were the findings?

The findings were compelling and should spur efforts to standardize twice-daily toothbrushing for all hospitalized patients, Dr. Jiang says.

Study participants who were randomly assigned to receive twice-daily toothbrushing were 33% less likely to develop hospital-acquired pneumonia. Those effects were magnified for people on ventilators, who needed this invasive breathing assistance for less time if their teeth were brushed.

Overall, study participants were 19% less likely to die in the ICU — and able to graduate from intensive care faster — with the twice-daily oral regimen.

How long patients stayed in the hospital or whether they were treated with antibiotics while there didn’t seem to influence pneumonia rates. Also, toothbrushing three or more times daily didn’t translate into additional benefits over brushing twice a day.

What were the study’s strengths and limitations?

One major strength was compiling years of smaller studies into one larger analysis — something particularly unusual in dentistry, Dr. Jiang says. “From a dental point of view, having 15 randomized controlled trials is huge. It’s very hard to amass that big of a population in dentistry at this high a level of evidence,” she says.

But toothbrushing techniques may have varied among hospitals participating in the research. And while the study was randomized, it couldn’t be blinded — a tactic that would reduce the chance of skewed results. Because there was no way to conceal toothbrushing regimens, clinicians involved in the study likely knew their efforts were being tracked, which may have changed their behavior.

“Perhaps they were more vigilant because of it,” Dr. Jiang says.

How exactly can toothbrushing prevent hospital-acquired pneumonia?

It’s not complicated. Pneumonia in hospitalized patients often stems from breathing germs into the mouth — germs which number more than 700 different species, including bacteria, fungi, viruses and other microbes.

This prospect looms larger for ventilated patients, since the breathing tube inserted into the throat can carry bacteria farther down the airway. “Ventilated patients lose the normal way of removing some of this bacteria,” Dr. Jiang says. “Without that ventilator, we can sweep it out of our upper airways.”

How much does toothbrushing matter if you’re not hospitalized?

In case you think the study findings only pertain to people in the hospital, think again. Rather, this drives home how vital it is for everyone to take care of their teeth and gums.

About 300 diseases and conditions are linked in some way to oral health. Poor oral health triggers some health problems and worsens others. People with gum disease and tooth loss, for example, have higher rates of heart attacks. And those with uncontrolled gum disease typically have more difficulty controlling blood sugar levels.

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Animals renowned for their outstanding night vision include owls, cats, tarsiers (a tiny primate in Southeast Asia) — and even the dung beetle.

But humans? Not so much.

Over time, many people suffer from night blindness, also known as nyctalopia. This condition makes seeing in dim or dark settings difficult because your eyes cannot adjust to changes in brightness or detect light.

What are the dangers for those experiencing night blindness?

Night blindness is especially problematic and dangerous when driving. Your eyes cannot adjust between darkness and the headlights of oncoming vehicles, other cars may appear out of focus, and your depth perception becomes impaired, which makes it difficult to judge distances.

Night blindness also may affect your sight at home by making it hard for your vision to quickly adjust to a dark room after turning off the lights. “This can cause people to bump into furniture or trip and suffer an injury,” says Dr. Isabel Deakins, an optometrist with Harvard-affiliated Massachusetts Eye and Ear.

What happens in the eye to create night blindness?

The ability to see in low-light conditions involves two structures in the eye: the retina and the iris.

The retina, located in the back of the eye, contains two types of light-detecting cells called cones and rods. The cones handle color vision and fine details while the rods manage vision in dim light.

The iris is the colored part of your eye. It contains muscles that widen or narrow the opening of your pupil to adjust how much light can enter your eyes.

If your irises don’t properly react, the pupils can dilate and let in too much light, which causes light sensitivity and makes it hard to see in bright light. Or your pupils may remain too small and not allow in enough light, making it tough to see in low light.

What causes night blindness?

Night blindness is not a disease but a symptom of other conditions. “It’s like having a bruise on your body. Something else causes it,” says Dr. Deakins.

Several conditions can cause night blindness. For instance, medications, such as antidepressants, antihistamines, and antipsychotics, can affect pupil size and how much light enters the eye.

Eye conditions that can cause night blindness include:

• glaucoma, a disease that damages the eye’s optic nerves and blood vessels
• cataracts, cloudy areas in the lens that distort or block the passage of light through the lens
• dry eye syndrome.

However, one issue that raises the risk of night blindness that you can’t control is age. “Our eyes react more slowly to light changes as we age, and vision naturally declines over time,” says Dr. Deakins.  “The number of rods in our eyes diminish, pupils get smaller, and the muscles of the irises weaken.”

What helps if you have night blindness?

If you notice any signs of night blindness, avoid driving and get checked by an eye care specialist like an optometrist or ophthalmologist. An eye exam can determine if your eyeglass prescription needs to be updated.

“Often, a prescription change is enough to reduce glare when driving at night," says Dr. Deakins. “You may even need separate glasses with a stronger eye prescription that you wear only when driving at night.”

Adding an anti-reflective coating to your lens may help to cut down on the glare of the headlights of an oncoming car. However, skip the over-the-counter polarized driving glasses sold at many drug stores. "These may help cut down on glare, but they don't address the causes of night blindness," says Dr. Deakins.

An eye exam also will identify glaucoma or cataracts, which can be treated. Glaucoma treatments include eyedrops, laser treatment, or surgery. Cataracts are corrected with surgery to replace the clouded lens with an artificial one. Your eye care specialist can also help identify dry eye and recommend treatment.

Ask your primary care clinician or a pharmacist if any medications that you take may cause night blindness. If so, it may be possible to adjust the dose or switch to another drug.

Three more ways to make night driving safer

You also can take steps to make night driving safer. For example:

• Wash the lenses of your glasses regularly. And take them to an optician to buff out minor scratches.
• Keep both sides of your front and rear car windshields clean so that you can see as clearly as possible.
• Dim your dashboard lights, which cause glare, and use the night setting on your rearview mirror.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD