To the Editor: Risk factors for pneumonia in older people include impaired cognitive function and limited ability to perform activities of daily living (ADLs). Silent aspiration due to a depressed swallowing reflex, which is mediated via substance P (SP), is another known risk factor.1 We recently reported that long-term oral care reduced the risk of pneumonia among elderly Japanese nursing home patients.2 However, it is not known whether intensive oral care affects these risk factors for pneumonia.