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The impact of hospitalization on oral health: a systematic review


  • Conflict of interest and sources of funding statement
    There was no external funding and all authors were supported by their institutions. This work was undertaken at UCLH/UCL, which received a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding scheme. There was no conflict of interest in this research.

Professor Ian Needleman
Unit of Periodontology & International Centre for Evidence-Based Oral Health
UCL Eastman Dental Institute
256 Gray's Inn Road
London WC1X 8LD


Terezakis E, Needleman I, Kumar N, Moles D, Agudo E: The impact of hospitalization on oral health: a systematic review. J Clin Periodontol 2011; doi: 10.1111/j.1600-051X.2011.01727.x.


Background: Poor oral health of hospitalized patients is associated with an increased risk of hospital-acquired infections and reduced life quality.

Objectives: To systematically review the evidence on oral health changes during hospitalization.

Data sources: Cochrane library, Medline, OldMedline, Embase and CINAHL without language restrictions.

Study eligibility criteria: Observational longitudinal studies.

Data appraisal and synthesis methods: Two independent reviewers screened studies for inclusion, assessed the risk of bias and extracted data. Risk of bias was assessed using the Newcastle–Ottawa assessment scale. A narrative synthesis was conducted.

Results: Five before and after studies were included. The data suggest a deterioration in oral health following hospitalization with an increase in dental plaque accumulation and gingival inflammation and a deterioration in mucosal health.

Limitations: While before and after studies are at a general risk of bias, other specific study characteristics were judged to have a low risk of bias. However, methodological issues such as unvalidated outcome measures and the lack of assessor training limit the strength of the evidence.

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