title: Oral microbial and respiratory status of persons with mental retardation/intellectual and developmental disability: an observational cohort study.
abstract: OBJECTIVE
  The objective of this study was to determine the prevalence of select microorganisms in oral biofilms and to investigate relationships between oral and respiratory status in persons with mental retardation/intellectual and developmental disabilities (IDD).
  
  
  METHODS
  We conducted a 6-month-long observational cohort study with 63 persons with IDD. Oral examinations, oral sampling, and medical record reviews were performed at baseline and then monthly. Polymerase chain reaction (PCR) was used to analyze all baseline oral samples for the presence of Streptococcus pneumoniae, Methicillin-resistant Staphylococcus aureus (MRSA), Prevotella melaninogenica, and Candida albicans. PCR analyses were also performed on participants' samples collected in the month before being diagnosed with a respiratory infection.
  
  
  RESULTS
  All subjects had P. melaninogenica detected by PCR in their oral samples. Fifty-five percent (35 of 63) of participants had S. pneumoniae, MRSA, and C. albicans in their oral samples at baseline. No dental decay was detected clinically, oral hygiene was fair, and dysphagia was common. During the 6 months of the study, there were 22 respiratory infections (35% of participants)-12 pneumonias, 7 sinusitis, 1 bronchitis, and 1 upper respiratory tract infection. Participants with microorganisms in their baseline samples were significantly more likely to develop any respiratory infection and those who had poor oral status were significantly more likely to develop pneumonia. Almost 60% of participants who developed respiratory infections had the same microorganism detected in the sample collected in the month before infection as had been detected in their baseline sample.
  
  
  CONCLUSIONS
  Potentially pathogenic microorganisms in the oral cavity and poor oral status significantly increased the risk of developing respiratory infections, including pneumonia, in persons with IDD. The results suggest that colonization with these microorganisms may persist despite routine tooth brushing. Meticulous comprehensive oral hygiene of the oral cavity may be needed to reduce oropharyngeal microbial load.
authors.affiliation: Department of Surgical and Hospital Dentistry, University of Louisville, Louisville, KY, USA. cjbink01@louisville.edu
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Binkley
authors.forename: Gilbert S
authors.initials: GS
authors.lastname: Haugh
authors.forename: Dinah H
authors.initials: DH
authors.lastname: Kitchens
authors.forename: Debra L
authors.initials: DL
authors.lastname: Wallace
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
mesh_terms: D018441:Biofilms; D002176:Candida albicans / Q000302:isolation & purification; D015331:Cohort Studies; D004269:DNA, Bacterial / Q000032:analysis; D004271:DNA, Fungal / Q000032:analysis; D003773:Dental Plaque / Q000382:microbiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D015999:Multivariate Analysis; D019989:Persons with Intellectual Disabilities / Q000706:statistics & numerical data*; D001443:Prevotella melaninogenica / Q000302:isolation & purification; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000382:microbiology*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification
chemical_list: D004269:DNA, Bacterial; D004271:DNA, Fungal