Risk of pneumonia and mortality after routine dental scaling in patients with moderate-to-severe cerebral palsy: A nationwide cohort study

Authors

• Li-Wei Ou-Yang, Department of Pediatric Dentistry, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Dental and Craniofacial Science, Chang Gung University College of Medicine, Taoyuan, Taiwan
• Ya-Ting Chang, Division of Pediatric Cardiology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
• Hsin-Mao Hsu, Division of Pediatric Cardiology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
• Shih-Hao Chang, Graduate Institute of Dental and Craniofacial Science, Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Periodontology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Dental Technology and Materials Science, College of Health Sciences, Central Taiwan University of Science and Technology, Taichung, Taiwan
• Chia-Ling Wu, Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
• Hui-Ju Tsai, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan; College of Life Sciences and Medicine, National Tsing-Hua University, Hsinchu, Taiwan
• Yu-Tung Huang, National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, TaiwanFollow
• Tsung-Chieh Yao, Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University College of Medicine, Taoyuan, TaiwanFollow

DOI

https://doi.org/10.1016/j.jds.2025.12.029

Abstract

Background/purpose

Pulmonary infection is a major cause of hospitalization and death in individuals with cerebral palsy. The impact of routine dental scaling, a standard procedure for removing oral biofilm, on the risk of pneumonia and mortality in individuals with cerebral palsy is unknown. This study aimed to investigate the association between routine dental scaling and the risk of pneumonia and mortality in individuals with moderate-to-severe cerebral palsy.

Materials and methods

This nationwide, population-based cohort study used data derived from Taiwan's National Health Insurance Research Database between 2009 and 2019. 12,853 individuals with moderate-to-severe cerebral palsy were identified. Individuals who received routine dental scaling for at least three consecutive years were compared to those without dental scaling. Propensity-score matching was applied to balance baseline characteristics. Multivariable Cox proportional hazards models and Fine–Gray competing-risks survival analyses were employed to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of pneumonia, pneumonia-related mortality, and all-cause mortality during 5-year follow-up period.

Results

Among 2,440 matched pairs, routine dental scaling was significantly associated with reduced risks of pneumonia (HR: 0.41, 95 % CI: 0.28–0.58), pneumonia-related mortality (HR: 0.23, 95 % CI: 0.13–0.41), and all-cause mortality (HR: 0.24, 95 % CI: 0.19–0.32). These findings remained consistent across various subgroup and sensitivity analyses.

Conclusion

This 11-year nationwide cohort study provides real-world evidence that routine dental scaling is associated with a substantially reduced risk of pneumonia and mortality in individuals with moderate-to-severe cerebral palsy. These findings highlight the importance of oral healthcare in preventing severe health outcomes in this vulnerable population.

Recommended Citation

Ou-Yang, Li-Wei; Chang, Ya-Ting; Hsu, Hsin-Mao; Chang, Shih-Hao; Wu, Chia-Ling; Tsai, Hui-Ju; Huang, Yu-Tung; and Yao, Tsung-Chieh, "Risk of pneumonia and mortality after routine dental scaling in patients with moderate-to-severe cerebral palsy: A nationwide cohort study" (2026). Articles in Press. 16.
https://jds.ads.org.tw/articles_in_press/16