{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T02:56:19Z","timestamp":1781232979131,"version":"3.54.1"},"reference-count":70,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Oral health has significant implications for pulmonary outcomes, particularly among individuals with dysphagia who are at risk for aspiration. Moreover, oral health and condition affect nutrition accessibility and status. Inadequate oral hygiene promotes bacterial colonization, plaque accumulation, and aspiration-related respiratory complications. This narrative review aimed to explore current evidence and expert perspectives across palliative medicine, pulmonary and critical care, and dentistry on the role of oral hygiene in supporting pulmonary health and maintaining opportunities for oral nutrition. A comprehensive literature search was conducted through the Texas Tech University Health Sciences Center digital library using Cochrane Library (Wiley), EBSCO Discovery, Embase, Ovid databases, PubMed, SCOPUS, ScienceDirect, Web of Science, and Google Scholar between 14 January 2026 and 1 April 2026. From 1287 identified records, 70 studies were selected to be highlighted in the manuscript after duplicate removal and eligibility screening. Relevant literature was reviewed to examine associations among dysphagia, oral health and condition, oral hygiene and care protocols, feeding route, salivary composition and function, and respiratory outcomes. Emphasis was placed on studies addressing pneumonia, oral versus tube feeding, and evidence-based oral care practices. Findings indicate that pneumonia, depression, and mortality rates are higher in patients receiving tube feeding compared to oral feeding. Evidence-based oral care practices inclusive of mechanical plaque disruption, oral cleansing products (Chlorhexidine, hydrogen peroxide, and sodium bicarbonate), and structured oral hygiene protocols can reduce pulmonary consequences of aspiration and support safer\/least risk oral intake. Saliva plays a pivotal role in plaque breakdown, microbial defense, and host immunity; oral feeding helps to preserve salivary function. Results of this review highlight the importance of oral hygiene in both restorative and palliative care contexts. This review establishes a framework for embedding oral cleansing agents and protocols into a nutrition-focused health care infrastructure. Based on the literature analysis and inter- and multidisciplinary clinical expertise of the author group, the manuscript proposes consensus statements intended as expert guidance rather than formal clinical practice guidelines. Adherence to best practices in oral care can mitigate pulmonary consequences of aspiration amid dysphagia, make oral nutrition more accessible and comfortable, sustain opportunities for least risk oral feeding across diagnoses and health care settings, and improve quality of life for patients with dysphagia amid life-limiting illness.<\/jats:p>","DOI":"10.3390\/nu18121888","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T01:52:08Z","timestamp":1781229128000},"page":"1888","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Narrative Review of Oral Hygiene and Pulmonary Health Amid Dysphagia: Implications for Feeding Route, Nutrition, and Quality of Life"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4695-1002","authenticated-orcid":false,"given":"Jennifer","family":"Hanners Gutierrez","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA"},{"name":"University Medical Center (UMC) Health System, Lubbock, TX 79415, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5489-233X","authenticated-orcid":false,"given":"Kenneth","family":"Iwuji","sequence":"additional","affiliation":[{"name":"Division of Pulmonary\/Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9426-9366","authenticated-orcid":false,"given":"Pragya","family":"Pandey","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry and Endodontics, King George\u2019s Medical University, Lucknow 226003, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6616-1662","authenticated-orcid":false,"given":"Kelly","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/j.mayocp.2020.08.001","article-title":"Dysphagia in older adults","volume":"96","author":"Thiyagalingam","year":"2021","journal-title":"Mayo Clin. Proc."},{"key":"ref_2","first-page":"97","article-title":"Dysphagia: Evaluation and collaborative management","volume":"103","author":"Wilkinson","year":"2021","journal-title":"Am. Fam. Physician"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.jcrc.2014.07.011","article-title":"Aspiration pneumonia: A review of modern trends","volume":"30","author":"DiBardino","year":"2015","journal-title":"J. Crit. Care"},{"key":"ref_4","first-page":"32","article-title":"The role of oral health in the prevention of systemic diseases","volume":"1","author":"Chan","year":"2024","journal-title":"Univers. Libr. Med. Health Sci."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Hanners Gutierrez, J., Klein, K., Bimali, M., and Sanders, J. (2025). Rethinking tube feeding in palliative care: Impact on pneumonia, depression, and mortality in patients with dysphagia and life-limiting illness. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0333895"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.jamda.2020.06.035","article-title":"The efficacy and safety of tube feeding in advanced dementia patients: A systemic review and meta-analysis study","volume":"22","author":"Lee","year":"2021","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e2460780","DOI":"10.1001\/jamanetworkopen.2024.60780","article-title":"Use of feeding tubes among hospitalized older adults with dementia","volume":"8","author":"Hartford","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3400","DOI":"10.1111\/odi.14755","article-title":"Severe chronic obstructive pulmonary disease is associated with reduced oral health conditions","volume":"30","author":"Ciardo","year":"2024","journal-title":"Oral Dis."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Dong, J., Li, W., Wang, Q., Chen, J., Zu, Y., Zhou, X., and Guo, Q. (2022). Relationships between oral microecosystem and respiratory diseases. Front. Mol. Biosci., 8.","DOI":"10.3389\/fmolb.2021.718222"},{"key":"ref_10","first-page":"e23750","article-title":"Efficacy of oral care protocols in the prevention of ventilator-associated pneumonia in mechanically ventilated patients","volume":"14","author":"Singh","year":"2022","journal-title":"Cureus"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.otohns.2005.03.059","article-title":"Physiologic model of oropharyngeal swallowing revisited","volume":"133","author":"Michel","year":"2005","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Chan, A.K., Tsang, Y.C., Jiang, C.M., Leung, K.C., Lo, E.C., and Chu, C.H. (2023). Diet, nutrition, and oral health in older adults: A review of the literature. Dent. J., 11.","DOI":"10.3390\/dj11090222"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1007\/s11894-023-00876-7","article-title":"Evaluation of esophageal dysphagia in elderly patients","volume":"25","author":"Le","year":"2023","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"50","DOI":"10.5005\/jp-journals-10023-1222","article-title":"Incidence of dysphagia in acute stroke patients: An early screening and management","volume":"11","author":"Chacko","year":"2021","journal-title":"Int. J. Phonosurg. Laryngol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Won, S.Y., Krieger, S., Dubinski, D., Gessler, F., Behmanesh, B., Freiman, T.M., Konczalla, J., Seifert, V., and Lapa, S. (2022). Neurogenic dysphagia in subdural hematoma. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.701378"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1055\/s-0043-1771458","article-title":"Dysphagia in neurological disorders","volume":"43","author":"Arwani","year":"2023","journal-title":"Semin. Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1007\/s00455-020-10199-8","article-title":"Abnormalities of aspiration and swallowing function in survivors of acute respiratory failure","volume":"36","author":"Langmore","year":"2021","journal-title":"Dysphagia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1080\/17476348.2022.2086123","article-title":"The prevalence of oropharyngeal dysphagia in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis","volume":"16","author":"Li","year":"2022","journal-title":"Expert Rev. Respir. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.aucc.2022.06.003","article-title":"Frequency, associated factors, and associated outcomes of dysphagia following sepsis","volume":"36","author":"Hongo","year":"2023","journal-title":"Aust. Crit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1002\/lary.29770","article-title":"Predictors of aspiration pneumonia and mortality in patients with dysphagia","volume":"132","author":"Nachalon","year":"2022","journal-title":"Laryngoscope"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1111\/apt.18193","article-title":"Oesophageal disorders in chronic liver disease","volume":"60","author":"Idalsoaga","year":"2024","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.jped.2023.09.004","article-title":"Risk of dysphagia in a population of infants born pre-term: Characteristic risk factors in a tertiary NICU","volume":"100","author":"Dewi","year":"2024","journal-title":"J. Pediatr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s13052-025-01903-1","article-title":"Swallowing disorders in cerebral palsy: A systematic review of oropharyngeal Dysphagia, nutritional impact, and health risks","volume":"51","author":"Calderone","year":"2025","journal-title":"Ital. J. Pediatr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S426","DOI":"10.1016\/j.amjms.2025.12.683","article-title":"Pharyngeal dysphagia: An early marker for genetic diagnosis","volume":"371","author":"Jenkins","year":"2026","journal-title":"Am. J. Med. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.otc.2024.02.012","article-title":"Oral structural dysphagia in children","volume":"57","author":"Eapen","year":"2024","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1007\/s00246-025-03953-y","article-title":"Prevalence, Clinical Factors and Impact of Dysphagia After Cardiac Surgery for Congenital Heart Disease","volume":"47","author":"Hahn","year":"2025","journal-title":"Pediatr. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.cger.2023.01.010","article-title":"Poor oral health in the etiology and prevention of aspiration pneumonia","volume":"39","author":"Scannapieco","year":"2023","journal-title":"Clin. Geriatr. Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Surdu, A., Foia, L.G., Luchian, I., Trifan, D., Tatarciuc, M.S., Scutariu, M.M., Ciupilan, C., and Budala, D.G. (2025). Saliva as a diagnostic tool for systemic diseases\u2014A narrative review. Medicina, 61.","DOI":"10.3390\/medicina61020243"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.job.2022.09.005","article-title":"A review on the role of salivary MUC5B in oral health","volume":"64","author":"Faruque","year":"2022","journal-title":"J. Oral Biosci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1164\/rccm.202201-0064ED","article-title":"The mucin gene MUC5B is required for normal lung function","volume":"205","author":"Liegeois","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Murray, J., and Affoo, R.H. (2024). Swallowing, xerostomia, and hyposalivation. Xerostomia, CRC Press.","DOI":"10.1201\/9781003526995-6"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s40136-023-00455-4","article-title":"Aspiration pneumonia and oral health","volume":"11","author":"Hamad","year":"2023","journal-title":"Curr. Otorhinolaryngol. Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1902\/annals.2001.6.1.78","article-title":"Oral bacteria and respiratory infection: Effects on respiratory pathogen adhesion and epithelial cell proinflammatory cytokine production","volume":"6","author":"Scannapieco","year":"2001","journal-title":"Ann. Periodontol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1093\/ageing\/afaa102","article-title":"Poor oral hygiene, oral microorganisms and aspiration pneumonia risk in older people in residential aged care: A systematic review","volume":"50","author":"Khadka","year":"2021","journal-title":"Age Ageing"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2124","DOI":"10.1111\/j.1532-5415.2008.01926.x","article-title":"A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: Effect estimates and methodological quality of randomized controlled trials","volume":"56","author":"Nilsson","year":"2008","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1046\/j.1532-5415.2001.49113.x","article-title":"Aspiration pneumonia: Dental and oral risk factors in an older veteran population","volume":"49","author":"Terpenning","year":"2001","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1016\/S0012-3692(15)31374-X","article-title":"Colonization of dental plaques: A reservoir of respiratory pathogens for hospital-acquired pneumonia in institutionalized elders","volume":"126","author":"Pietrantoni","year":"2004","journal-title":"Chest"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1562","DOI":"10.1086\/593193","article-title":"Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation","volume":"47","author":"Heo","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1056\/NEJM200103013440908","article-title":"Aspiration pneumonitis and aspiration pneumonia","volume":"344","author":"Marik","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1056\/NEJMra1714562","article-title":"Aspiration pneumonia","volume":"380","author":"Mandell","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1902\/jop.2001.72.1.50","article-title":"Potential associations between chronic respiratory disease and periodontal disease: Analysis of National Health and Nutrition Examination Survey III","volume":"72","author":"Scannapieco","year":"2001","journal-title":"J. Periodontol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1902\/jop.2006.060010","article-title":"Systematic review of the association between respiratory diseases and oral health","volume":"77","author":"Azarpazhooh","year":"2006","journal-title":"J. Periodontol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1016\/j.clnu.2017.03.014","article-title":"Relationship of nutritional status and oral health in elderly: Systematic review with meta-analysis","volume":"37","author":"Toniazzo","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Algra, Y., Haverkort, E., Kok, W., Etten-Jamaludin, F.V., Schoot, L.V., Hollaar, V., Naumann, E., Schueren, M.D., and Jerkovi\u0107-\u0106osi\u0107, K. (2021). The association between malnutrition and oral health in older people: A systematic review. Nutrients, 13.","DOI":"10.3390\/nu13103584"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1111\/idh.12560","article-title":"Use of toothbrushing in conjunction with chlorhexidine for preventing ventilator-associated pneumonia: A random-effect meta-analysis of randomized controlled trials","volume":"21","author":"Sozkes","year":"2023","journal-title":"Int. J. Dent. Hyg."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Yamakita, S., Unoki, T., Niiyama, S., Natsuhori, E., Haruna, J., and Kuribara, T. (2024). Comparative efficacy of various oral hygiene care methods in preventing ventilator-associated pneumonia in critically ill patients: A systematic review and network meta-analysis. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0313057"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s44158-024-00166-2","article-title":"Chlorhexidine is not effective at any concentration in preventing ventilator-associated pneumonia: A systematic review and network meta-analysis","volume":"4","author":"Pettenuzzo","year":"2024","journal-title":"J. Anesth. Analg. Crit. Care"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.bjid.2016.06.005","article-title":"Effects of hydrogen peroxide mouthwash on preventing ventilator-associated pneumonia in patients admitted to the intensive care unit","volume":"20","author":"Nobahar","year":"2016","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Huang, H., Yu, X., Huang, C., Zeng, J., and Li, Y. (2025). Oral care medications for the prevention and treatment of ventilator-associated pneumonia in intensive care unit. Front. Oral Health, 6.","DOI":"10.3389\/froh.2025.1566355"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"8841722","DOI":"10.1155\/2020\/8841722","article-title":"A systematic review of the effect of oral rinsing with H2O2 on clinical and microbiological parameters related to plaque, gingivitis, and microbes","volume":"2020","author":"Muniz","year":"2020","journal-title":"Int. J. Dent."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"S74","DOI":"10.1016\/j.identj.2023.08.010","article-title":"Mouthwash effects on the oral microbiome: Are they good, bad, or balanced?","volume":"73","author":"Brookes","year":"2023","journal-title":"Int. Dent. J."},{"key":"ref_52","first-page":"2","article-title":"The effect of alkalinization of oral cavity by sodium bicarbonate mouth wash to decrease ventilator-associated pneumonia in traumatic brain injury patients: A prospective randomized controlled study","volume":"46","author":"Loha","year":"2022","journal-title":"Trends Anaesth. Crit. Care"},{"key":"ref_53","first-page":"2361","article-title":"Prevention of neonatal ventilator-associated pneumonia through oral care with the combined use of colostrum and sodium bicarbonate","volume":"25","author":"Li","year":"2021","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"23337214241269848","DOI":"10.1177\/23337214241269848","article-title":"Pneumonia, depression, and mortality are impacted by feeding route in patients with dysphagia","volume":"10","author":"Lazarus","year":"2024","journal-title":"Gerontol. Geriatr. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1007\/s12603-014-0487-3","article-title":"A comparison of survival, pneumonia, and hospitalization in patients with advanced dementia and dysphagia receiving either oral or enteral nutrition","volume":"18","author":"Cintra","year":"2014","journal-title":"J. Nutr. Health Aging"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1016\/j.jamda.2022.03.011","article-title":"Reduced pneumonia risk in advanced dementia patients on careful hand feeding compared with nasogastric tube feeding","volume":"23","author":"Yuen","year":"2022","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.clnu.2016.01.008","article-title":"A large prospective audit of morbidity and mortality associated with feeding gastrostomies in the community","volume":"36","author":"Clarke","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/j.gie.2022.06.031","article-title":"Improving 30-day mortality after PEG tube placement in England from 2007 to 2019: A retrospective national cohort analysis of 87,862 patients","volume":"96","author":"Kamran","year":"2022","journal-title":"Gastrointest. Endosc."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e2023.00005","DOI":"10.4293\/JSLS.2023.00005","article-title":"Factors associated with mortality after percutaneous endoscopic gastrostomy","volume":"27","author":"Lima","year":"2023","journal-title":"J. Soc. Laparosc. Robot. Surg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00784-025-06392-4","article-title":"Endoscopic surveillance of poor oral hygiene in vulnerable patients at pneumonia risk","volume":"29","author":"Chang","year":"2025","journal-title":"Clin. Oral Investig."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1007\/s00455-014-9553-6","article-title":"Oral care may reduce pneumonia in the tube-fed elderly: A preliminary study","volume":"29","author":"Maeda","year":"2014","journal-title":"Dysphagia"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Lambert, E. (2018). Secretion management. Pediatric Dysphagia: Challenges and Controversies, Springer International Publishing.","DOI":"10.1007\/978-3-319-97025-7_20"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1097\/CCM.0000000000004181","article-title":"Impact of a progressive mobility program on the functional status, respiratory, and muscular systems of ICU patients: A randomized and controlled trial","volume":"48","author":"Schujmann","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.clnu.2017.09.003","article-title":"ESPEN guideline clinical nutrition in neurology","volume":"37","author":"Burgos","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Drancourt, N., El Osta, N., Decerle, N., and Hennequin, M. (2022). Relationship between oral health status and oropharyngeal dysphagia in older people: A systematic review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192013618"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Jun, M.K., Ku, J.K., Kim, I.H., Park, S.Y., Hong, J., Kim, J.Y., and Lee, J.K. (2021). Hospital dentistry for intensive care unit patients: A comprehensive review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10163681"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1111\/idj.12397","article-title":"Is it necessary to have a dentist within an intensive care unit team? Report of a randomised clinical trial","volume":"68","author":"Menegueti","year":"2018","journal-title":"Int. Dent. J."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"62","DOI":"10.4103\/0970-258X.272134","article-title":"Mobile teeth: An underestimated risk factor for lung infections in critical care settings","volume":"32","author":"Uppal","year":"2019","journal-title":"Natl. Med. J. India"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.otorri.2017.12.002","article-title":"Multi-disciplinary clinical protocol for the diagnosis of bulbar amyotrophic lateral sclerosis","volume":"70","author":"Chiaramonte","year":"2019","journal-title":"Acta Otorrinolaringol. Engl. Ed."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Pizzorni, N. (2017). Social and psychologic impact of dysphagia. Dysphagia: Diagnosis and Treatment, Springer International Publishing.","DOI":"10.1007\/174_2017_132"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/12\/1888\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T02:00:04Z","timestamp":1781229604000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/12\/1888"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":70,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["nu18121888"],"URL":"https:\/\/doi.org\/10.3390\/nu18121888","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]}}}