Pulmonary infections have had an enormous impact on the population, both from a health, as well as an economic perspective. Billions of dollars have been spent on both outpatient and inpatient costs of pneumonia and respiratory disease-related health care. Based on the analysis presented of the current evidence, oral disease can now be added to smoking, air pollution, secondhand smoke, history of childhood respiratory infections, genetic factors, and heredity as a primary risk factor for respiratory diseases.

Prevention of exposure to risk factors thus constitutes an important component for decreasing the chances of the occurrence of respiratory disease. Part of this approach involves preventing or diminishing the transmission of potential pathogens into the respiratory tract from extrapulmonary sources such as the oral cavity, particularly in high-risk individuals such as hospitalized and ICU patients, nursing home residents, the elderly, infants, and young children. Clearly, oral hygiene can contribute significantly to this prevention.

It is significant that this article confirms the results of the only other systematic review of the relationship between oral and respiratory disease, providing dental professionals an additional degree of confidence that the associations are real and merit serious consideration relative to clinical practice. Given the strength of the evidence regarding the link between oral bacteria and respiratory diseases, it appears critical that patients with current respiratory disease and medically complex patients, especially those at risk for respiratory diseases, receive frequent and periodic oral health assessment and care.