Although oral hygiene may not seem to be as much a “major league” issue as cardiovascular disease (CVD), diabetes, or dyslipidemia, poor oral hygiene status has actually been linked to important outcomes, including pneumonia and CVD. Although the mechanisms are incompletely understood, gingival and periodontal inflammation seen in persons with poor oral hygiene is associated with worse CVD outcomes, perhaps due to systemic consequences of local inflammation.

Of course, there are other consequences to poor oral hygiene including tooth loss, halitosis, and eating difficulties. Yet, there has been little attention paid in the medical literature to simple steps that might improve oral health in long-term care facilities. Although mechanical tooth-brushing on a regular basis would doubtless be helpful, this would be a somewhat labor-intensive intervention for staff to participate in.

Gutkowski performed a small pilot study based on the premise that xylitol, a five-carbon sugar commonly found in many fruits and vegetables, might be helpful to improve oral hygiene, since oropharyngeal bacteria are not able to use five-carbon sugars to create their self-protective biofilm in which they establish long-term residence, leading to tooth decay, calculus, and periodontal disease. Since xylitol is readily available in chewing gum, and many adults of all ages find chewing gum to be a pleasant activity, a pilot trial (n = 6) to ascertain the effect on oral biofilm through xylitol gum chewed twice daily for 3 months was undertaken. In addition to the xylitol gum, residents were also asked to apply a calcium/phosphorus-containing mineral paste called “MI Paste” twice daily, to additionally help prevent tooth decay.

At the end of the 3 months, there was a readily visible (as seen through the use of dental disclosure tablets) improvement in biofilm levels. Simple steps may make important inroads in oral health for persons in long-term care facilities.