Registered Nurses' Association of Ontario


  • Poor oral health affects the ability to sleep well, especially in the presence of pain, and impacts on a person’s perception of self – both their self-esteem and self-confidence.
  • Conditions such as cardiovascular disease, diabetes, respiratory diseases and adverse pregnancy outcomes can be linked to oral health status.
  • Periodontal diseases (periodontitis and gingivitis) are multifactoral diseases with bacterial infiltration as an essential component. Bacterial infection of the supporting structures of the teeth elicits an inflammatory response.
  • This chronic infection and inflammation of the gums establishes a systemic burden via the blood stream of bacterial pathogens, bacterial antigens, endotoxins and inflammatory cytokines.
  • Potential impact of moderate to severe periodontitis on the body:
    • Adverse Pregnancy Outcomes: 4-7 times greater risk
    • Chronic Respiratory Disease: 2-5 times greater risk
    • Coronary Artery Disease: 2 times greater risk
    • Diabetes: 2-4 times greater risk
    • Stroke: 2 times greater risk
  • The greatest burden of oral disease is to disadvantaged and poor population groups, both in developing, and developed countries.
  • Aspiration of oropharyngeal (including periodontal) pathogens is the dominant cause of nursing home-acquired pneumonia; factors reflecting poor oral health strongly correlate with increased risk of developing aspiration pneumonia.
  • Persons with mental illness:
    • Several factors contribute to the poor oral health of the person with mental illness:
      • The negative symptoms of schizophrenia, which may include apathy and avolition, decrease a person’s interest in attending to oral hygiene.
      • Cognitive deficits associated with schizophrenia and schizoaffective disorder can interfere with attention, memory, concentration and problem-solving skills.
      • Some medications used in the treatment of both schizophrenia and depression have an anticholinergic effect resulting in xerostomia. This hypo-salivation can result in rapid tooth decay and periodontal disease.
      • Many people with psychiatric illness have limited finances which adversely impacts on their nutritional status and the ability to access treatment in the community.
      • Those with bipolar disorder exhibit one of the highest rates of associated substance abuse among all the major psychiatric illness.
  • In addition to the physical effects of prescription medications, substance abuse including alcohol, cocaine, heroin and marijuana also can lead to gingivitis or tooth loss.
  • The Surgeon’s General’s report on oral health indicates that individuals with mental retardation or with other developmental disabilities, including Down’s Syndrome and Cerebral Palsy, have significantly higher rates of poor oral hygiene and an increased need for periodontal treatment than the general population.
  • Hospitalized survivors of acute stroke experience numerous sources of stress that can adversely affect oral health.
  • The ability to provide ones’ own oral care may be impacted by variety of causes including, but not limited to, arthritic conditions, neurological diseases and amputations.
  • Mucositis is a painful complication of chemotherapy and/or radiotherapy, and good oral hygiene protocols are important.
  • Smoking has significant effects on the oral cavity, including oral cancers and pre-cancers, increased severity and extent of periodontal diseases, and poor wound healing.
Clinical Management
Oral Health: Nursing Assessment and Intervention
Background Information