A Narrative Review of Oral Hygiene and Pulmonary Health Amid Dysphagia: Implications for Feeding Route, Nutrition, and Quality of Life

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.