Original Research

Pathogenic oral bacteria in hospitalised patients with dysphagia: The silent epidemic

Merryl J. Weimers, Mershen Pillay
South African Journal of Communication Disorders | Vol 68, No 1 | a798 | DOI: https://doi.org/10.4102/sajcd.v68i1.798 | © 2021 Merryl J. Weimers, Mershen Pillay | This work is licensed under CC Attribution 4.0
Submitted: 16 October 2020 | Published: 30 July 2021

About the author(s)

Merryl J. Weimers, Department of Speech Pathology and Audiology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Mershen Pillay, Department of Speech Pathology and Audiology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; and, Speech and Language Therapy, Massey University, Auckland, New Zealand; and, Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom

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Background: Aspiration pneumonia is a serious and fatal complication of dysphagia, secondary to the ingestion of bacteria-laden secretions. However, no studies have documented the oral hygiene features present in patients who present with dysphagia.

Objectives: The purpose of this study was to describe the oral hygiene problems of adults admitted to a sub-acute rehabilitation hospital and who presented with dysphagia.

Methods: A descriptive, cross-sectional survey was conducted, during which 40 participants – 57.5% (n = 23) male and 42.5% (n = 17) female – underwent a clinical swallow evaluation using the Mann Assessment of Swallowing Ability (MASA) augmented with cervical auscultation (CA) and pulse oximetry (PO), an oral hygiene assessment using an adapted version of the Oral Health Assessment Tool (OHAT), followed by microbiology laboratory analysis of buccal swab samples to detect bacteria not considered part of the normal oral flora.

Results: Results indicated that poor oral hygiene status was a common feature amongst all participants who presented with dysphagia. The most prevalent oral hygiene issues were related to abnormalities concerning saliva (60%), oral cleanliness (82.5%), the tongue (80%) and the use of dentures (71.4%). A high prevalence, 62.5% (n = 25), of opportunistic bacteria was found. The most commonly occurring bacteria groups were: (1) Candida albicans (47.5%) and (2) respiratory pathogens (37.5%) such as Klebsiella pneumoniae and Staphylococcus aureus.

Conclusion: Persons with dysphagia have poor oral hygiene which creates favourable environments for bacteria to flourish and increases the prevalence of pathogenic oral bacteria associated with the development of aspiration pneumonia. The management of oral health issues for persons with dysphagia should receive greater attention during hospitalisation.


dysphagia; oral hygiene; aspiration pneumonia; oral bacteria; hospitalised patients


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