Discussion
xerostomia, impaired swallowing function
DENTAL CARIES, XEROSTOMIA, PERIODONTAL DISEASES, DENTAL PLAQUE, PLAQUE, CAVITY, DENTAL PLAQUE, ASPIRATION PNEUMONIA
This study showed that bacteria that spread into the oral cavity by brushing cannot be completely recovered by wiping, and that mouthwashing is essential after brushing. In addition, although the amount of dental plaque does not directly affect the number of bacteria in saliva, it has been suggested that the number of bacteria in saliva may increase when the number of remaining teeth decreases, owing to poor oral hygiene, resulting in a decline in oral function.Dental plaque is an aggregate of microorganisms and a risk factor for dental caries and periodontal diseases. Therefore, daily brushing of teeth is common to remove dental plaque. However, the number of bacteria in saliva contaminated by brushed-off dental plaque has not been examined. In this study, the number of Total Bacteria in the saliva increased immediately after brushing. This was thought to be a temporary increase because plaque adhering to the teeth was removed by brushing and mixed with saliva. Brushing by caregivers and medical personnel is typically performed for older adults and postoperative patients who are unable to brush by themselves. However, this increase in the number of bacteria in saliva immediately after brushing may increase the risk of aspiration pneumonia due to the aspiration of saliva in patients with impaired swallowing function. Therefore, it is necessary to be especially conscious of the need to collect contaminated saliva frequently during brushing and to establish a brushing method that prevents plaque from falling into the oral cavity during brushing.The effectiveness of wiping and mouthwashing as a method for collecting contaminated saliva, which temporarily increases bacterial counts due to brushing, was investigated. In clinical practice, it is difficult for older adults requiring nursing care or for patients to rinse their mouths immediately after surgery, and caregivers often brush them with suction or wipes. However, the results of the present study indicated that wiping is insufficient for collecting bacteria during brushing. Hayashida et al. examined oral care methods for intubated patients and reported that washing with tap water effectively reduced the number of bacteria in pharyngeal effluents [As described above, it is important to swish around the mouth or perform oral irrigation with water after brushing; however, when this is not possible, it is necessary to establish new oral care methods, such as wiping and mouthwashing with antiseptic agents. This study also examined the factors affecting the number of bacteria in the saliva before brushing. The results showed that the bacterial count was significantly higher when the number of remaining teeth was lower or the OHI-DI score was higher. Previous reports have identified age and xerostomia as factors affecting the number of bacteria in the saliva of perioperative patients [This study has several limitations. First, the study was conducted on a small number of patients at a single institution, and it is not clear whether the results obtained can be generalized. In addition, oral function tests, which are thought to be the most important factors influencing salivary bacterial counts, were not performed. Furthermore, mouthwashes after brushing were performed with water, and the effect of mouthwashes with disinfectants, such as povidone-iodine, was not examined. We would like to investigate these points further in the future.