27th April 2026

Newsletter Monday

Reader

I’ve not been able to stop thinking about an article in New Scientist last week.

It described a study looking at dental care in hospital patients.

The results haven’t been fully published yet - they were presented at a conference - so I’m not going to get carried away with the headline.

But that’s not really the point.

The study itself was large. Around 8,800 patients across several hospitals.

It was a randomised trial looking at whether improving oral care - giving patients toothbrushes, toothpaste, and some basic support - made any difference to rates of hospital-acquired pneumonia.

It did.

The results…

Fewer cases of hospital-acquired pneumonia in the group receiving regular oral care.

Yes, thats correct.

The group that brushed their teeth were significantly less likely to develop pneumonia during their stay.

Pneumonia in someone who is bed-bound and unwell is serious and too often, fatal

And when I read it, I didn’t think “that’s surprising.”

I thought, yes… that rings true.

Once upon a time.

I worked as a healthcare assistant for years before qualifying as a doctor.

And one of the core parts of that role is helping patients with personal care.

Washing. Changing. Brushing teeth.

What I’ve not forgotten is this.

When someone feels truly unwell -properly poorly, bed-bound, exhausted - they don’t care that their hair isn’t washed.

They don’t care that they haven’t shaved.

They don’t care that their teeth feel grim.

They want to be clean enough, comfortable, and then left alone to sleep.

And when you’re looking after them, you prioritise accordingly.

You make sure they’re not soiled.

You change the sheets.

You get them into fresh nightwear.

And by that point, they’re often spent.

So the teeth… get missed.

Not through neglect.

Through reality.

What struck me is that I had never really joined the dots.

The idea that something as simple as brushing teeth might influence the risk of pneumonia hadn’t properly landed.

Which is odd, when I think about what I see now.

Cause of death.

In my role as a Medical Examiner, I regularly review deaths where someone has been admitted, become bed-bound, developed a hospital-acquired pneumonia… and deteriorated quickly.

It’s very common. And often rapid.

So when you look at it through that lens, the biology makes sense.

Bacteria in the mouth.

Reduced swallowing.

Reduced mobility.

A bit of dehydration.

Aspiration.

It doesn’t take much to tip things.

Meanwhile on planet Facebook

Around the same time, I was sent another clip from Facebook about fluoride.

Someone online suggesting it was harmful.

I get these fairly regularly.

Global consensus that something is good = someone online says otherwise.

Somehow we've ended up focusing a lot of attention on what’s in toothpaste…

…while missing whether teeth are being brushed at all.

And that, for me, is the bigger message.

Not just about oral care.

About health more broadly.

We are very good at getting drawn into:

• new ideas
• complex explanations
• things that sound clever

But maintaining good health?

Still comes down to the basics.

Done consistently.

• Movement.
• Food.
• Sleep.
• Controlled stress.

And yes - sometimes something as unglamorous as brushing your teeth.

It’s not exciting.

It doesn’t sell particularly well.
​

But it does work.