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Gomes FS, Campos-Ferreira PV, Macedo RFCD, Costa-Oliveira BE, Bauer J. Glass ionomer cement particles pre-reacted with chlorhexidine: Physical/chemical properties and antimicrobial activity. J Mech Behav Biomed Mater 2024; 158:106678. [PMID: 39096683 DOI: 10.1016/j.jmbbm.2024.106678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVE Analyze the effects of the functionalization of pre-functionalized GIC particles with chlorhexidine on the physicochemical properties and antimicrobial activity. MATERIALS AND METHODS Four groups were prepared: (1) GIC (Bioglass R - Biodinamica) - control group; (2) GIC-CHX 1%: Group containing 1% pre-reacted CHX particles; (3) GIC-CHX 2.5%: Group containing 2.5% pre-reacted CHX particles; (4) GIC-CHX 5%: Group containing 5% pre-reacted CHX particles. Hourglass-shaped specimens (10 mm × 2 mm x 1 mm) were fabricated for mechanical tests including cohesive strength (n = 12), modulus of elasticity (n = 12) and microhardness (n = 10). Discs (10 mm × 2 mm) were prepared for the analysis of Ca+2, PO4- and F- ions release (n = 3), and roughness (n = 12). To evaluate the setting time, a Gilmore needle was used according to ISO 9917-1:2016. Disk-shaped specimens (5 × 1mm) were manufactured and subjected to bacterial activity (n = 9) (Streptococcus mutans ATCC 159). RESULTS Modulus, roughness, setting time and ions release (Ca+2, PO4-, and F-) there were no statistically significant differences among the groups (p > 0.05). The setting time did not change with the incorporation of CHX. The GIC-CHX 2.5% and GIC-CHX 5% groups exhibited superior antibacterial activity compared to the control group and GIC-CHX 1% (p < 0.001). The GIC-CHX 5% group showed the highest microhardness values (p < 0.041), cohesive strength (p < 0.009) when compared to the control group. CONCLUSION The pre-reacted CHX in GICs was able to confer antimicrobial activity, improve cohesive strength, microhardness, and did not impair ion release, setting time, and roughness.
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Affiliation(s)
- Felipe Silva Gomes
- Dentistry Biomaterials Laboratory (Biomma), School of Dentistry, Federal University of Maranhão (UFMA), 65080-805, São Luís, MA, Brazil
| | - Paulo Vitor Campos-Ferreira
- Dentistry Biomaterials Laboratory (Biomma), School of Dentistry, Federal University of Maranhão (UFMA), 65080-805, São Luís, MA, Brazil
| | | | | | - Jose Bauer
- Dentistry Biomaterials Laboratory (Biomma), School of Dentistry, Federal University of Maranhão (UFMA), 65080-805, São Luís, MA, Brazil.
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2
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Cimoli M, Gibney J, Lim M, Castles J, Dammert P. Nil per os in the management of oropharyngeal dysphagia-exploring the unintended consequences. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1410023. [PMID: 38957683 PMCID: PMC11217566 DOI: 10.3389/fresc.2024.1410023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/04/2024] [Indexed: 07/04/2024]
Abstract
Nil per os (NPO), also referred to as Nil by Mouth (NBM), is a health-related intervention of withholding food and fluids. When implemented in the context of a person with dysphagia, NPO aims to mitigate risks of aspiration. However, evidence demonstrating that NPO is beneficial as an intervention for people with dysphagia is lacking. This paper explores the theoretical and empirical evidence relating to the potential benefits and adverse effects of NPO and asserts that NPO is not a benign intervention. This paper argues for applying an ethics framework when making decisions relating to the use of NPO as an intervention for dysphagia, in particular addressing informed consent and a person's right to self-determination.
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Affiliation(s)
- Michelle Cimoli
- Speech PathologyDepartment, Allied Health Division, Austin Health, Heidelberg, VIC, Australia
| | - Jennifer Gibney
- Speech Pathology Department, Nepean Hospital, Penrith, NSW, Australia
| | - Mathew Lim
- Dental Services, Alfred Health, Prahran, VIC, Australia
- Melbourne Dental School, University of Melbourne, Carlton, VIC, Australia
| | - Jo Castles
- Speech PathologyDepartment, Allied Health Division, Austin Health, Heidelberg, VIC, Australia
| | - Pedro Dammert
- Pulmonary and Critical Care Department, Scripps Mercy Hospital Chula Vista, Chula Vista, CA, United States
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Vucelić V, Bratić V, Negovetić Vranić D, Tambić Andrašević A, Degoricija V, Mihaljević Z, Ramić S, Piteša Košutić I, Šimunović L, Špiljak B, Brailo V. Understanding and Practices of Oral Hygiene in the Intensive Care Units: Perspectives of Medical Staff at Two University Hospital Centers. Acta Stomatol Croat 2024; 58:85-93. [PMID: 38562223 PMCID: PMC10981905 DOI: 10.15644/asc58/1/8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Objective This study assesses the knowledge, practices, and attitudes of medical staff in intensive care units (ICUs) regarding oral hygiene care for critically ill, bedridden patients. Material and methods A cross-sectional study included 65 employees from the Intensive Care Units of the Sestre Milosrdnice Clinical Hospital Centre (CHC SM) and the Clinic for Anesthesiology and Intensive Care at the University Clinical Hospital Centre Zagreb (CHC ZG). A self-administered questionnaire was used to assess knowledge, methods, frequency, and attitudes towards oral care for mechanically ventilated patients. The data were examined through descriptive statistical methods, presented in terms of proportions (percentages). For the purpose of comparing the feedback across the two hospital centers and different educational backgrounds, the Chi-square and Fisher's exact tests were employed. Results Results of a survey of 65 participants (18 from CHC SM and 47 from CHC ZG) revealed a notable disparity in oral hygiene knowledge, with graduate nurses displaying the highest proportion of adequate knowledge (100%) and regular nurses showing the least (30.3%) (p<.001). Although the execution of oral care practices did not vary significantly among the groups, graduate nurses performed oral care more frequently (80% vs. baccalaureate technicians 33.33% and nurses 57.6%, three or more times a day) and demonstrated better proficiency in both mechanical (p=.005) and chemical (p<.001) biofilm management compared to their counterparts. No significant difference was observed in the delivery of oral care to orotracheally intubated patients across different educational levels (p=.127). However, a marked difference was noted in the perception of being adequately trained for such care, with nurses feeling less prepared (12.1%, p<.001). Despite these variances, all respondents recognized the importance of oral hygiene, thus showing a strong dedication to oral health care. Conclusions: This study highlights variability in ICU oral hygiene practices and points to the importance of standardized care protocols and improved training for healthcare staff.
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Affiliation(s)
- Vesna Vucelić
- Intensive Care Unit of the University Department of Medicine, Clinical Hospital Centre “Sestre milosrdnice”
| | - Vesna Bratić
- Clinic for Anesthesiology and Intensive Care, University Clinical Hospital Centre Zagreb
| | - Dubravka Negovetić Vranić
- University of Zagreb, School of Dental Medicine, Zagreb, Croatia
- Clinic for Dentistry, University Clinical Hospital Centre Zagreb
| | - Arjana Tambić Andrašević
- University of Zagreb, School of Dental Medicine, Zagreb, Croatia
- Department of Clinical Microbiology, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, Zagreb, Croatia
| | - Vesna Degoricija
- Intensive Care Unit of the University Department of Medicine, Clinical Hospital Centre “Sestre milosrdnice”
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Zlatan Mihaljević
- Department of Clinical Microbiology, Clinical Hospital Centre “Sestre milosrdnice”
| | - Snježana Ramić
- Department of Oncological Pathology and Clinical Cytology “Ljudevit Jurak”, University Department of Pathology, Clinical Hospital Centre “Sestre milosrdnice”
| | - Ivana Piteša Košutić
- Intensive Care Unit of the University Department of Medicine, Clinical Hospital Centre “Sestre milosrdnice”
| | - Luka Šimunović
- University of Zagreb, School of Dental Medicine, Zagreb, Croatia
| | - Bruno Špiljak
- University of Zagreb, School of Dental Medicine, Zagreb, Croatia
| | - Vlaho Brailo
- University of Zagreb, School of Dental Medicine, Zagreb, Croatia
- Clinic for Dentistry, University Clinical Hospital Centre Zagreb
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Pindoria A, Macintyre L, Doshi M. A service evaluation of mouth care referrals for adult inpatients in an acute hospital. Br Dent J 2023:10.1038/s41415-023-6497-y. [PMID: 37978219 DOI: 10.1038/s41415-023-6497-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 11/19/2023]
Abstract
Introduction Healthcare professionals working in hospitals often have inadequate training in supporting patients with mouth care, which is one reason oral health deteriorates in hospitalised patients.Aim The aim of this service evaluation is to assess the main reasons healthcare professionals request advice from the mouth care lead nurse and identify common trends.Method Data were collected for patients referred to the mouth care lead between 2020-2022, including age, sex, reason for referral, outcome and whether the patient needed redirecting to a dentist or doctor.Results A total of 204 referrals were analysed and 93% of patients referred were aged over 65 years of age. The most common reason for hospital admission was cancer (14%), followed by falls (9%) and stroke (7%). The most common reasons for mouth care referral were dry mouth (43%), poor oral hygiene (15%) and loose dentures (14%). Overall, 62% patients were deceased within a year of the referral.Conclusion This evaluation shows there is value in having a dedicated mouth care lead nurse who can provide training to staff when required for individual patients. Inpatients tend to be older, often in their last year of life, and there is a need to focus training on dry mouth.
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Affiliation(s)
| | | | - Mili Doshi
- Consultant in Special Care Dentistry, East Surrey Hospital, UK
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Ren Y, Liang J, Li X, Deng Y, Cheng S, Wu Q, Song W, He Y, Zhu J, Zhang X, Zhou H, Yin J. Association between oral microbial dysbiosis and poor functional outcomes in stroke-associated pneumonia patients. BMC Microbiol 2023; 23:305. [PMID: 37875813 PMCID: PMC10594709 DOI: 10.1186/s12866-023-03057-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Despite advances in our understanding of the critical role of the microbiota in stroke patients, the oral microbiome has rarely been reported to be associated with stroke-associated pneumonia (SAP). We sought to profile the oral microbial composition of SAP patients and to determine whether microbiome temporal instability and special taxa are associated with pneumonia progression and functional outcomes. METHODS This is a prospective, observational, single-center cohort study that examined patients with acute ischemic stroke (AIS) who were admitted within 24 h of experiencing a stroke event. The patients were divided into three groups based on the occurrence of pneumonia and the use of mechanical ventilation: nonpneumonia group, SAP group, and ventilator-associated pneumonia (VAP) group. We collected oral swabs at different time points post-admission and analyzed the microbiota using 16 S rRNA high-throughput sequencing. The microbiota was then compared among the three groups. RESULTS In total, 104 nonpneumonia, 50 SAP and 10 VAP patients were included in the analysis. We found that SAP and VAP patients exhibited significant dynamic differences in the diversity and composition of the oral microbiota and that the magnitude of this dysbiosis and instability increased during hospitalization. Then, by controlling the potential effect of all latent confounding variables, we assessed the changes associated with pneumonia after stroke and explored patients with a lower abundance of Streptococcus were more likely to suffer from SAP. The logistic regression analysis revealed that an increase in specific taxa in the phylum Actinobacteriota was linked to a higher risk of poor outcomes. A model for SAP patients based on oral microbiota could accurately predict 30-day clinical outcomes after stroke onset. CONCLUSIONS We concluded that specific oral microbiota signatures could be used to predict illness development and clinical outcomes in SAP patients. We proposed the potential of the oral microbiota as a non-invasive diagnostic biomarker in the clinical management of SAP patients. CLINICAL TRIAL REGISTRATION NCT04688138. Registered 29/12/2020, https://clinicaltrials.gov/ct2/show/NCT04688138 .
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Affiliation(s)
- Yueran Ren
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jingru Liang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiao Li
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yiting Deng
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Sanping Cheng
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qiheng Wu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Wei Song
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yan He
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiajia Zhu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaomei Zhang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hongwei Zhou
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - Jia Yin
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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Leira Y, Cho H, Marletta D, Orlandi M, Diz P, Kumar N, D'Aiuto F. Complications and treatment errors in periodontal therapy in medically compromised patients. Periodontol 2000 2023; 92:197-219. [PMID: 36166645 DOI: 10.1111/prd.12444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
Patients who are medically compromised may be at an increased risk of complications and treatment errors following periodontal therapy. A review of the evidence on the topic is presented, in relation to the type of complication reported, of periodontal treatment, and of patients' medical status. Further, a framework for risk assessment and appropriate treatment modifications is introduced, with the aim of facilitating the management of patients with existing comorbidities and reducing the incidence of treatment complications.
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Affiliation(s)
- Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
- Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela & Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Hana Cho
- Special Care Dentistry Unit, ENT & Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | | | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
| | - Pedro Diz
- Special Care Dentistry Unit, Faculty of Odontology, University of Santiago de Compostela & Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Navdeep Kumar
- Special Care Dentistry Unit, ENT & Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
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Narbutaitė J, Skirbutytė G, Virtanen JI. Oral care in intensive care units: Lithuanian nurses' attitudes and practices. Acta Odontol Scand 2023:1-6. [PMID: 36597772 DOI: 10.1080/00016357.2022.2163285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIM This study examines the attitudes and practices of ICU nurses towards the provision of oral care to their patients. OBJECTIVE We conducted this cross-sectional survey about oral health care practices in ICUs in Lithuania. METHODS We used a self-administered 20-item questionnaire to survey the current oral care practices, training, and attitudes of 108 nurses. The questionnaire was based on previous studies to gather information related to the attitudes, oral care practices, and training of ICU nurses. We used the chi-square test to analyze relationships between the categorical variables. RESULTS Most (88, 82%) of the nurses stated that oral care is important. Although most (83, 77%) had adequate training, a clear majority (98, 91%) of the nurses reported a willingness to learn more. Most (78, 72%) of the nurses found the oral cavity difficult to clean, and (71, 66%) found doing so unpleasant. When performing oral care, the nurses used mostly foam swabs (62, 61%) and moisturizers (54, 53%). More than half (57, 57%) of the nurses expressed a need for more hospital support. CONCLUSIONS Nurses working in ICUs reported that oral care is a high priority for their patients, but a difficult and unpleasant task. Nurses provided oral care mainly with toothbrushes, foam swabs, and moisturizers.
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Affiliation(s)
- Julija Narbutaitė
- Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gertrūda Skirbutytė
- Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jorma I Virtanen
- Faculty of Medicine, University of Bergen, Bergen, Norway.,Institute of Dentistry, University of Turku, Finland
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Cruz ASDC, Fidelis YP, de Mendonça Guimarães D, Muller HS, Martins VDP, Lia EN. Oral health and the presence of infectious microorganisms in hospitalized patients: a preliminary observational study. Ann Med 2022; 54:1908-1917. [PMID: 36073637 PMCID: PMC9467618 DOI: 10.1080/07853890.2022.2092895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Characterise oral health, and the presence in the oral cavity of pathogenic non-oral microorganisms potentially associated with nosocomial infections and antimicrobial resistance in non-intubated patients admitted to a Brazilian university hospital. MATERIALS AND METHODS An intraoral examination and oral swab were performed on hospitalized individuals at three different times, T1 (within 48 h of hospitalization), T2 (48 h after T1) and T3 (7 days after hospitalization). The oral health status was defined by the Oral Health Assessment Tool (OHAT) and Tongue Coating Status (TCS). The swabs were processed and microorganisms potentially related to nosocomial infections were phenotypically identified through colony morphology, staining and microscopy. RESULTS The most prevalent microorganisms were Escherichia coli, Enterococcus spp., Enterobacter spp., Pseudomonas spp., Candida albicans and Staphylococcus aureus. The oral health status was considered median, and the tongue coating index was considered high throughout the study period. The prevalence of potentially pathogenic non-oral microorganisms was high and constant from the first 48 h to the seventh day of hospitalization. CONCLUSIONS The results point out that the mouth can act as a reservoir of epidemiologically important pathogens within hospital settings, even in patients without mechanical ventilation, thus increasing the risk of nosocomial infections in susceptible individuals. KEY MESSAGESThe present study investigated the oral health status and the presence of pathogenic non-oral microorganisms in the oral cavity of patients hospitalized in the ward, non-intubated and mostly independent of self-care.The presence in the mouth of microorganisms related to the epidemiology of nosocomial infections and resistance to antimicrobials was high and constant from the first 48 h to the 7th day of hospitalization.The results of this study point out that the mouth can act as a reservoir of epidemiologically important pathogens within hospital settings even in patients without mechanical ventilation, increasing the risk of nosocomial infections in susceptible individuals.
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Affiliation(s)
| | - Yara Peixoto Fidelis
- Faculty of Health Sciences, Dentistry Department, University of Brasília, Brasília, Brazil
| | | | - Herick Sampaio Muller
- Laboratory of Molecular Analysis of Pathogens, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - Vicente de Paulo Martins
- Laboratory of Molecular Analysis of Pathogens, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - Erica Negrini Lia
- Postgraduate Program in Dentistry, University of Brasília, Brasília, Brazil.,Faculty of Health Sciences, Dentistry Department, University of Brasília, Brasília, Brazil
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Singh P, Arshad Z, Srivastava VK, Singh GP, Gangwar RS. Efficacy of Oral Care Protocols in the Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Patients. Cureus 2022; 14:e23750. [PMID: 35518542 PMCID: PMC9064705 DOI: 10.7759/cureus.23750] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/05/2022] Open
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Oral Hygiene Practice among Hospitalized Patients: An Assessment by Dental Hygiene Students. Healthcare (Basel) 2022; 10:healthcare10010115. [PMID: 35052279 PMCID: PMC8775311 DOI: 10.3390/healthcare10010115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 11/24/2022] Open
Abstract
Aim: An epidemiological study was carried out, in hospital wards, with the aim of assessing the oral health status of patients subjected to multiple medical treatments. Material and Methods: The study was conducted at Fondazione IRCCS Policlinico San Matteo (Pavia, Italy). A questionnaire was submitted to patients for the evaluation of oral hygiene devices used; then, a clinical examination was conducted to collect Decayed Missing Filled Teeth (DMFT) index, Plaque Index (PI), and Marginal Gingival Index (MGI) values. Results: Manual toothbrushes were used by a wide range of the sample study (65–100% among hospital wards), together with mouthwash (20–80%); interproximal aids were used by few patients (the lowest recorded value was 33.3%). Conclusion: dental hygienists could be integrated into hospital wards as oral hygiene procedure instructors, for the improvement of the oral health conditions of hospitalized patients.
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Doshi M. Mouth care training and practice: a survey of nursing staff working in National Health Service hospitals in England. J Res Nurs 2021; 26:574-590. [PMID: 35265164 PMCID: PMC8899309 DOI: 10.1177/17449871211016524] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background This study investigated the training and mouth care practice of nursing staff in hospital Trusts across England. Oral health has been found to deteriorate during hospital admission, mouth care standards have been found to be poor. Aims The objectives of the study were to assess if and what the barriers are to supporting inpatients' mouth care, and to assess how confident nursing staff are in carrying out mouth care assessments and mouth care and see if this is related to previous training. Methods A cross-sectional descriptive survey was conducted in 33 Trusts in England with 1576 members of the nursing team including nurses and nursing assistants. Nursing staff were asked to complete a questionnaire on previous oral health training and their current practice. Results Nursing staff reported that they had limited training in mouth care. The main barriers to mouth care were time and patient compliance. Confidence in recognising oral cancer was low. Conclusions Nursing staff would benefit from mouth care training targeted at assessing the mouth and providing mouth care for all inpatients.
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Affiliation(s)
- Mili Doshi
- Consultant in Special Care Dentistry, Surrey and Sussex Healthcare Trust, UK
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12
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Jerônimo LS, Esteves Lima RP, Suzuki TYU, Discacciati JAC, Bhering CLB. Oral Candidiasis and COVID-19 in Users of Removable Dentures: Is Special Oral Care Needed? Gerontology 2021; 68:80-85. [PMID: 33853063 PMCID: PMC8089415 DOI: 10.1159/000515214] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/08/2021] [Indexed: 01/08/2023] Open
Abstract
Elderly patients with systemic disorders and immunocompromised patients seem to have a higher risk of developing morbidity from COVID-19. Candida albicans (C. albicans) is a potentially dangerous pathogen for these patients, especially for denture wearers with prosthetic stomatitis who require mechanical ventilation. C. albicans infection, the main candidiasis infection associated with denture wear, can complicate COVID-19 and increase the associated morbidity and mortality. Therefore, early diagnosis of C. albicans infection in COVID-19 patients is important to establish more effective antifungal treatment methods and prophylaxis strategies. Hospitalized COVID-19 patients should undergo an oral examination to assess their oral health, and those with poor oral health should receive the appropriate care and monitoring.
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Affiliation(s)
- Laura Silva Jerônimo
- Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rafael Paschoal Esteves Lima
- Department of Clinic, Pathology and Dental Surgery, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Thaís Yumi Umeda Suzuki
- Department of Restorative Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Zhao T, Wu X, Zhang Q, Li C, Worthington HV, Hua F. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev 2020; 12:CD008367. [PMID: 33368159 PMCID: PMC8111488 DOI: 10.1002/14651858.cd008367.pub4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, swab, toothbrush, or combination, together with suction of secretions, may reduce the risk of VAP in these patients. OBJECTIVES To assess the effects of oral hygiene care (OHC) on incidence of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation in hospital intensive care units (ICUs). SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 25 February 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2020, Issue 1), MEDLINE Ovid (1946 to 25 February 2020), Embase Ovid (1980 to 25 February 2020), LILACS BIREME Virtual Health Library (1982 to 25 February 2020) and CINAHL EBSCO (1937 to 25 February 2020). We also searched the VIP Database (January 2012 to 8 March 2020). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the effects of OHC (mouthrinse, gel, swab, toothbrush or combination) in critically ill patients receiving mechanical ventilation for at least 48 hours. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed search results, extracted data and assessed risk of bias in included studies. We contacted study authors for additional information. We reported risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, using the random-effects model of meta-analysis when data from four or more trials were combined. MAIN RESULTS We included 40 RCTs (5675 participants), which were conducted in various countries including China, USA, Brazil and Iran. We categorised these RCTs into five main comparisons: chlorhexidine (CHX) mouthrinse or gel versus placebo/usual care; CHX mouthrinse versus other oral care agents; toothbrushing (± antiseptics) versus no toothbrushing (± antiseptics); powered versus manual toothbrushing; and comparisons of other oral care agents used in OHC (other oral care agents versus placebo/usual care, or head-to-head comparisons between other oral care agents). We assessed the overall risk of bias as high in 31 trials and low in two, with the rest being unclear. Moderate-certainty evidence from 13 RCTs (1206 participants, 92% adults) shows that CHX mouthrinse or gel, as part of OHC, probably reduces the incidence of VAP compared to placebo or usual care from 26% to about 18% (RR 0.67, 95% confidence intervals (CI) 0.47 to 0.97; P = 0.03; I2 = 66%). This is equivalent to a number needed to treat for an additional beneficial outcome (NNTB) of 12 (95% CI 7 to 128), i.e. providing OHC including CHX for 12 ventilated patients in intensive care would prevent one patient developing VAP. There was no evidence of a difference between interventions for the outcomes of mortality (RR 1.03, 95% CI 0.80 to 1.33; P = 0.86, I2 = 0%; 9 RCTs, 944 participants; moderate-certainty evidence), duration of mechanical ventilation (MD -1.10 days, 95% CI -3.20 to 1.00 days; P = 0.30, I2 = 74%; 4 RCTs, 594 participants; very low-certainty evidence) or duration of intensive care unit (ICU) stay (MD -0.89 days, 95% CI -3.59 to 1.82 days; P = 0.52, I2 = 69%; 5 RCTs, 627 participants; low-certainty evidence). Most studies did not mention adverse effects. One study reported adverse effects, which were mild, with similar frequency in CHX and control groups and one study reported there were no adverse effects. Toothbrushing (± antiseptics) may reduce the incidence of VAP (RR 0.61, 95% CI 0.41 to 0.91; P = 0.01, I2 = 40%; 5 RCTs, 910 participants; low-certainty evidence) compared to OHC without toothbrushing (± antiseptics). There is also some evidence that toothbrushing may reduce the duration of ICU stay (MD -1.89 days, 95% CI -3.52 to -0.27 days; P = 0.02, I2 = 0%; 3 RCTs, 749 participants), but this is very low certainty. Low-certainty evidence did not show a reduction in mortality (RR 0.84, 95% CI 0.67 to 1.05; P = 0.12, I2 = 0%; 5 RCTs, 910 participants) or duration of mechanical ventilation (MD -0.43, 95% CI -1.17 to 0.30; P = 0.25, I2 = 46%; 4 RCTs, 810 participants). AUTHORS' CONCLUSIONS Chlorhexidine mouthwash or gel, as part of OHC, probably reduces the incidence of developing ventilator-associated pneumonia (VAP) in critically ill patients from 26% to about 18%, when compared to placebo or usual care. We did not find a difference in mortality, duration of mechanical ventilation or duration of stay in the intensive care unit, although the evidence was low certainty. OHC including both antiseptics and toothbrushing may be more effective than OHC with antiseptics alone to reduce the incidence of VAP and the length of ICU stay, but, again, the evidence is low certainty. There is insufficient evidence to determine whether any of the interventions evaluated in the studies are associated with adverse effects.
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Affiliation(s)
- Tingting Zhao
- Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xinyu Wu
- Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qi Zhang
- Department of Oral Implantology, The Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Fang Hua
- Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Centre for Evidence-Based Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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14
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Moreno Sancho F, Tsakos G, Brealey D, Boniface D, Needleman I. Development of a tool to assess oral health-related quality of life in patients hospitalised in critical care. Qual Life Res 2019; 29:559-568. [PMID: 31655973 PMCID: PMC6994456 DOI: 10.1007/s11136-019-02335-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2019] [Indexed: 11/25/2022]
Abstract
AIMS AND OBJECTIVES Oral health deteriorates following hospitalisation in critical care units (CCU) but there are no validated measures to assess effects on oral health-related quality of life (OHQoL). The objectives of this study were (i) to develop a tool (CCU-OHQoL) to assess OHQoL amongst patients admitted to CCU, (ii) to collect data to analyse the validity, reliability and acceptability of the CCU-OHQoL tool and (iii) to investigate patient-reported outcome measures of OHQoL in patients hospitalised in a CCU. METHODS The project included three phases: (1) the development of an initial questionnaire informed by a literature review and expert panel, (2) testing of the tool in CCU (n = 18) followed by semi-structured interviews to assess acceptability, face and content validity and (3) final tool modification and testing of CCU-OHQoL questionnaire to assess validity and reliability. RESULTS The CCU-OHQoL showed good face and content validity and was quick to administer. Cronbach's alpha was 0.72 suggesting good internal consistency. For construct validity, the CCU-OHQoL was strongly and significantly correlated (correlation coefficients 0.71, 0.62 and 0.77, p < 0.01) with global OHQoL items. In the validation study, 37.8% of the participants reported a deterioration in self-reported oral health after CCU admission. Finally, 26.9% and 31% of the participants reported considerable negative impacts of oral health in their life overall and quality of life, respectively. CONCLUSIONS The new CCU-OHQoL tool may be of use in the assessment of oral health-related quality of life in CCU patients. Deterioration of OHQoL seems to be common in CCU patients.
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Affiliation(s)
- Federico Moreno Sancho
- Unit of Periodontology, UCL Eastman Dental Institute, 1st Floor Levy wing, 256 Gray's Inn Road, London, WC1X 8LD, UK.
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, 1 - 19 Torrington Place, London, WC1E 7HB, UK
| | - David Brealey
- Bloomsbury Institute of Intensive Care Medicine, UCL, London, UK
| | - David Boniface
- Epidemiology and Public Health, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London, WC1X 8LD, UK
- Biostatistics, UCL Eastman Dental Institute, UCL, 256 Gray's Inn Road, London, WC1X 8LD, UK
| | - Ian Needleman
- Unit of Periodontology, UCL Eastman Dental Institute, 1st Floor Levy wing, 256 Gray's Inn Road, London, WC1X 8LD, UK
- Centre for Oral Health and Performance, UCL Eastman Dental Institute, UCL, 256 Gray's Inn Road, London, WC1X 8LD, UK
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15
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Araújo MM, Albuquerque BN, Cota LOM, Cortelli SC, Cortelli JR, Costa FO. Periodontitis and Periodontopathogens in Individuals Hospitalized in the Intensive Care Unit: A Case-Control Study. Braz Dent J 2019; 30:342-349. [PMID: 31340223 DOI: 10.1590/0103-6440201902480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/13/2019] [Indexed: 11/22/2022] Open
Abstract
The aim of the present study was to compare periodontal conditions between intensive care unit (ICU) in-patients and non-ICU patients through clinical and microbiological periodontal parameters. This case-control study included 88 individuals hospitalized in ICU and 176 non-hospitalized controls. All individuals underwent a complete periodontal examination and microbiological sampling. The total bacterial load and counts of Porphyromonas gingivalis, Treponema denticola and Aggregatibacter actinomycetemcomitans were evaluated using qPCR. Data were analyzed through the Chi-square, Fisher exact, and t-Student tests, and the Spearman correlation, as appropriate. The prevalence of periodontitis was 39.7% among controls and 59.0% among ICU in-patients (OR=2.18; p=0.002). ICU in-patients had a significantly higher occurrence of cardiovascular disease (p=0.002; OR=2.20) and history of periodontal disease (p=0.031; OR=1.92) than controls. Bacterial counts of A. actinomycetemcomitans, T. denticola and P. gingivalis were significantly higher in ICU in-patients with periodontitis than in controls. The correlation between periodontal parameters and microbiological findings among cases and controls showed a significant and positive correlation between: total bacteria load and % of sites with probing depth (PD) ≥ 4 mm (cases: r=0.22 and controls: r=0.13) and P. gingivalis and % sites with bleeding on probing (BOP) (cases: r=0.22 and controls: r=0.23). Thus, ICU in-patients presented a higher prevalence of periodontitis and worse periodontal condition (higher mean plaque index, BOP, clinical attachment level ≥3 mm, and sites with PD 4 to 6 mm).
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Affiliation(s)
- Milena Moreira Araújo
- Department of Periodontology, UFMG Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Luís Otávio Miranda Cota
- Department of Periodontology, UFMG Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Sheila Cavalca Cortelli
- Department of Periodontology, UFMG Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - José Roberto Cortelli
- Department of Periodontology, UFMG Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Fernando Oliveira Costa
- Department of Periodontology, UFMG Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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16
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Blum DFC, Silva JASD, Baeder FM, Della Bona Á. The practice of dentistry in intensive care units in Brazil. Rev Bras Ter Intensiva 2018; 30:327-332. [PMID: 30183977 PMCID: PMC6180464 DOI: 10.5935/0103-507x.20180044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 05/04/2018] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the practice of dentistry in intensive care units. Methods An observational survey study was conducted in which questionnaires were sent
via the online platform for collaboration in intensive care research in
Brazil (AMIBnet). The study was carried out from June to October 2017. The
questionnaires, which contained 26 closed questions about hospitals and
dentistry practices in the intensive care units, were sent to 4,569
professionals from different specialties practicing in the units. Results In total, 203 questionnaires were returned, resulting in a response rate of
4.44%. Most of the responses were from intensive care units in the Southeast
region of the country (46.8%). Public hospitals (37.9%) and private
hospitals (36.4%) had similar participation rates. Of the respondents, 55%
indicated that a bedside dentistry service was present, and they were
provided in different ways. Conclusion The presence of dentistry services and oral health service delivery training
and protocols were correlated. The oral care methods varied greatly among
the intensive care units surveyed.
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Affiliation(s)
| | | | | | - Álvaro Della Bona
- Faculdade de Odontologia, Universidade de Passo Fundo - Passo Fundo (RS), Brasil
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17
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Albuquerque BN, Araújo MM, Silva TA, Cota LOM, Cortelli SC, Costa FO. Periodontal Condition and Immunological Aspects of Individuals Hospitalized in the Intensive Care Unit. Braz Dent J 2018; 29:301-308. [PMID: 29972458 DOI: 10.1590/0103-6440201802034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/16/2018] [Indexed: 11/22/2022] Open
Abstract
There are few studies on the clinical and immunological periodontal status of intensive care unit (ICU) in-patients. The aim of the present study was to evaluate the periodontal condition among ICU in-patients through clinical and immunological periodontal parameters. From the sample of 373 hospitalized ICU patients, 182 were submitted' to a thorough clinical periodontal and immunological evaluation. Data on bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were collected and gingival sulcular fluid samples were quantified through ELISA on IL-1, IL-6, and MMP-2 for immunological evaluation. Data was statistically analyzed by Chi-square, Fisher's exact, Mann-Whitney tests, and Sperman's correlation and multivariate logistic regression analysis. A high dental plaque index and a high prevalence of periodontitis (48.3%), mostly in moderate and localized chronic form, were observed. Individuals with periodontitis presented higher levels of IL-1 and MMP-2, while individuals with cardiovascular disease (CVD) and individuals with two or more systemic diseases (MSD) presented higher levels of IL-1; diabetes mellitus (DM) and MSD individuals presented higher levels of IL-6. A positive association was found between the severity of periodontitis and CVD (OR 2.2; CI = 1.11-4.42). This study reported a 48.3% of the prevalence of periodontitis in ICU patients and a positive association between the severity of periodontitis and CVD. Additionally, higher levels of IL-1 and MMP-2 were found in individuals with periodontitis, higher levels of IL-6 were found in individuals with DM, and higher levels of IL-1 were found in individuals with CVD.
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Affiliation(s)
| | | | | | | | - Sheila Cavalca Cortelli
- UFMG - Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.,UNITAU - Universidade de Taubaté, Taubaté, SP, Brazil
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18
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Marino PJ, Hannigan A, Haywood S, Cole JM, Palmer N, Emanuel C, Kinsella T, Lewis MAO, Wise MP, Williams DW. Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study. BMJ Open Respir Res 2016; 3:e000150. [PMID: 27843549 PMCID: PMC5073587 DOI: 10.1136/bmjresp-2016-000150] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/15/2016] [Accepted: 08/21/2016] [Indexed: 01/14/2023] Open
Abstract
Introduction During critical illness, dental plaque may serve as a reservoir of respiratory pathogens. This study compared the effectiveness of toothbrushing with a small-headed toothbrush or a foam-headed swab in mechanically ventilated patients. Methods This was a randomised, assessor-blinded, split-mouth trial, performed at a single critical care unit. Adult, orally intubated patients with >20 teeth, where >24 hours of mechanical ventilation was expected were included. Teeth were cleaned 12-hourly using a foam swab or toothbrush (each randomly assigned to one side of the mouth). Cleaning efficacy was based on plaque scores, gingival index and microbial plaque counts. Results High initial plaque (mean=2.1 (SD 0.45)) and gingival (mean=2.0 (SD 0.54)) scores were recorded for 21 patients. A significant reduction compared with initial plaque index occurred using both toothbrushes (mean change=−1.26, 95% CI −1.57 to −0.95; p<0.001) and foam swabs (mean change=−1.28, 95% CI −1.54 to −1.01; p<0.001). There was significant reduction in gingival index over time using toothbrushes (mean change=−0.92; 95% CI −1.19 to −0.64; p<0.001) and foam swabs (mean change=−0.85; 95% CI −1.10 to −0.61; p<0.001). Differences between cleaning methods were not statistically significant (p=0.12 for change in gingival index; p=0.24 for change in plaque index). There was no significant change in bacterial dental plaque counts between toothbrushing (mean change 3.7×104 colony-forming units (CFUs); minimum to maximum (−2.5×1010 CFUs, 8.7×107 CFUs)) and foam swabs (mean change 9×104 CFUs; minimum to maximum (−3.1×1010 CFUs, 3.0×107 CFUs)). Conclusions Patients admitted to adult intensive care had poor oral health, which improved after brushing with a toothbrush or foam swab. Both interventions were equally effective at removing plaque and reducing gingival inflammation. Trial registration number NCT01154257; Pre-results.
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Affiliation(s)
| | - Ailish Hannigan
- Graduate Entry Medical School, University of Limerick , Limerick , Ireland
| | - Sean Haywood
- School of Dentistry, Cardiff University , Cardiff , UK
| | - Jade M Cole
- Adult Critical Care , University Hospital of Wales , Cardiff , UK
| | - Nicki Palmer
- Adult Critical Care , University Hospital of Wales , Cardiff , UK
| | | | | | | | - Matt P Wise
- Adult Critical Care , University Hospital of Wales , Cardiff , UK
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19
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Sands KM, Wilson MJ, Lewis MAO, Wise MP, Palmer N, Hayes AJ, Barnes RA, Williams DW. Respiratory pathogen colonization of dental plaque, the lower airways, and endotracheal tube biofilms during mechanical ventilation. J Crit Care 2016; 37:30-37. [PMID: 27621110 DOI: 10.1016/j.jcrc.2016.07.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/10/2016] [Accepted: 07/24/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE In mechanically ventilated patients, the endotracheal tube is an essential interface between the patient and ventilator, but inadvertently, it also facilitates the development of ventilator-associated pneumonia (VAP) by subverting pulmonary host defenses. A number of investigations suggest that bacteria colonizing the oral cavity may be important in the etiology of VAP. The present study evaluated microbial changes that occurred in dental plaque and lower airways of 107 critically ill mechanically ventilated patients. MATERIALS AND METHODS Dental plaque and lower airways fluid was collected during the course of mechanical ventilation, with additional samples of dental plaque obtained during the entirety of patients' hospital stay. RESULTS A "microbial shift" occurred in dental plaque, with colonization by potential VAP pathogens, namely, Staphylococcus aureus and Pseudomonas aeruginosa in 35 patients. Post-extubation analyses revealed that 70% and 55% of patients whose dental plaque included S aureus and P aeruginosa, respectively, reverted back to having a predominantly normal oral microbiota. Respiratory pathogens were also isolated from the lower airways and within the endotracheal tube biofilms. CONCLUSIONS To the best of our knowledge, this is the largest study to date exploring oral microbial changes during both mechanical ventilation and after recovery from critical illness. Based on these findings, it was apparent that during mechanical ventilation, dental plaque represents a source of potential VAP pathogens.
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Affiliation(s)
- Kirsty M Sands
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, Cardiff, Wales, UK.
| | - Melanie J Wilson
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, Cardiff, Wales, UK
| | - Michael A O Lewis
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, Cardiff, Wales, UK
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Nicki Palmer
- Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Anthony J Hayes
- Bioimaging Hub, School of Biosciences, Cardiff University, Cardiff, Wales, UK
| | - Rosemary A Barnes
- Cardiff Institute of Infection & Immunity, School of Medicine, Heath Park, Cardiff, Wales, UK
| | - David W Williams
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, Cardiff, Wales, UK
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20
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Tada A, Nakayama-Imaohji H, Yamasaki H, Hasibul K, Yoneda S, Uchida K, Nariya H, Suzuki M, Miyake M, Kuwahara T. Cleansing effect of acidic L-arginine on human oral biofilm. BMC Oral Health 2016; 16:40. [PMID: 27001253 PMCID: PMC4802732 DOI: 10.1186/s12903-016-0194-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 03/10/2016] [Indexed: 11/26/2022] Open
Abstract
Background Dental plaque formed on tooth surfaces is a complex ecosystem composed of diverse oral bacteria and salivary components. Accumulation of dental plaque is a risk factor for dental caries and periodontal diseases. L-arginine has been reported to decrease the risk for dental caries by elevating plaque pH through the activity of arginine deiminase in oral bacteria. Here we evaluated the potential of L-arginine to remove established oral biofilms. Methods Biofilms were formed using human saliva mixed with Brain Heart Infusion broth supplemented with 1 % sucrose in multi-well plates or on plastic discs. After washing the biofilms with saline, citrate (10 mM, pH3.5), or L-arginine (0.5 M, pH3.5), the retained biofilms were analyzed by crystal violet staining, scanning electron microscopy, and Illumina-based 16S rDNA sequencing. Results Washing with acidic L-arginine detached oral biofilms more efficiently than saline and significantly reduced biofilm mass retained in multi-well plates or on plastic discs. Illumina-based microbiota analysis showed that citrate (pH3.5) preferentially washed out Streptococcus from mature oral biofilm, whereas acidic L-arginine prepared with 10 mM citrate buffer (pH3.5) non-specifically removed microbial components of the oral biofilm. Conclusions Acidic L-arginine prepared with citrate buffer (pH3.5) effectively destabilized and removed mature oral biofilms. The acidic L-arginine solution described here could be used as an additive that enhances the efficacy of mouth rinses used in oral hygiene. Electronic supplementary material The online version of this article (doi:10.1186/s12903-016-0194-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ayano Tada
- Department of Microbiology, Faculty of Medicine, Kagawa University, 1750-1, Miki, Kagawa, 761-0793, Japan.,Department of Dental Oral Surgery, Faculty of Medicine, Kagawa University, 1750-1, Miki, Kagawa, 761-0793, Japan
| | - Haruyuki Nakayama-Imaohji
- Department of Microbiology, Faculty of Medicine, Kagawa University, 1750-1, Miki, Kagawa, 761-0793, Japan
| | - Hisashi Yamasaki
- Department of Cellular and Molecular Medicine, Wakayama Medical University Graduate School of Medicine, Wakayama, 641-8509, Japan
| | - Khaleque Hasibul
- Department of Dental Oral Surgery, Faculty of Medicine, Kagawa University, 1750-1, Miki, Kagawa, 761-0793, Japan
| | - Saori Yoneda
- Department of Microbiology, Faculty of Medicine, Kagawa University, 1750-1, Miki, Kagawa, 761-0793, Japan
| | - Keiko Uchida
- Department of Microbiology, Faculty of Medicine, Kagawa University, 1750-1, Miki, Kagawa, 761-0793, Japan
| | - Hirofumi Nariya
- Department of Microbiology, Faculty of Medicine, Kagawa University, 1750-1, Miki, Kagawa, 761-0793, Japan
| | - Motoo Suzuki
- Department of Microbiology, Faculty of Medicine, Kagawa University, 1750-1, Miki, Kagawa, 761-0793, Japan
| | - Minoru Miyake
- Department of Dental Oral Surgery, Faculty of Medicine, Kagawa University, 1750-1, Miki, Kagawa, 761-0793, Japan
| | - Tomomi Kuwahara
- Department of Microbiology, Faculty of Medicine, Kagawa University, 1750-1, Miki, Kagawa, 761-0793, Japan.
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21
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Trouillet JL, Luyt CE, Brechot N, Chastre J. Intérêt des soins de bouche et du brossage des dents dans la prévention des pneumonies acquises sous ventilation mécanique. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-015-1148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Sands KM, Twigg JA, Lewis MAO, Wise MP, Marchesi JR, Smith A, Wilson MJ, Williams DW. Microbial profiling of dental plaque from mechanically ventilated patients. J Med Microbiol 2015; 65:147-159. [PMID: 26690690 PMCID: PMC5115166 DOI: 10.1099/jmm.0.000212] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Micro-organisms isolated from the oral cavity may translocate to the lower airways during mechanical ventilation (MV) leading to ventilator-associated pneumonia (VAP). Changes within the dental plaque microbiome during MV have been documented previously, primarily using culture-based techniques. The aim of this study was to use community profiling by high throughput sequencing to comprehensively analyse suggested microbial changes within dental plaque during MV. Bacterial 16S rDNA gene sequences were obtained from 38 samples of dental plaque sampled from 13 mechanically ventilated patients and sequenced using the Illumina platform. Sequences were processed using Mothur, applying a 97 % gene similarity cut-off for bacterial species level identifications. A significant ‘microbial shift’ occurred in the microbial community of dental plaque during MV for nine out of 13 patients. Following extubation, or removal of the endotracheal tube that facilitates ventilation, sampling revealed a decrease in the relative abundance of potential respiratory pathogens and a compositional change towards a more predominantly (in terms of abundance) oral microbiota including Prevotella spp., and streptococci. The results highlight the need to better understand microbial shifts in the oral microbiome in the development of strategies to reduce VAP, and may have implications for the development of other forms of pneumonia such as community-acquired infection.
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Affiliation(s)
- Kirsty M Sands
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, UK
| | - Joshua A Twigg
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, UK
| | - Michael A O Lewis
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, UK
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Julian R Marchesi
- School of Biosciences, Main Building, Park Place, Cardiff University, Cardiff, Wales, UK.,Centre for Digestive and Gut Health, Imperial College London, London, UK
| | - Ann Smith
- School of Biosciences, Main Building, Park Place, Cardiff University, Cardiff, Wales, UK
| | - Melanie J Wilson
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, UK
| | - David W Williams
- Oral and Biomedical Sciences, School of Dentistry, Cardiff University, UK
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23
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Saddki N, Mohamad Sani FE, Tin-Oo MM. Oral care for intubated patients: a survey of intensive care unit nurses. Nurs Crit Care 2014; 22:89-98. [PMID: 25349099 DOI: 10.1111/nicc.12119] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 03/05/2014] [Accepted: 06/18/2014] [Indexed: 12/28/2022]
Abstract
AIMS This study aimed to determine attitudes and practices of intensive care unit (ICU) nurses towards provision of oral care for intubated patients. BACKGROUND Oral care is as an essential nursing intervention for intubated patients to maintain patient comfort and prevent colonization of dental plaque by respiratory pathogens. DESIGN This was a cross-sectional study. METHODS Data were collected from 93 ICU nurses of a teaching hospital in the East Coast of Peninsular Malaysia using a self-administered questionnaire. RESULTS Some nurses agreed that oral cavity of intubated patients was difficult (40·8%) and unpleasant (16·2%) to clean, but all of them realized the importance of oral care and the majority (97·9%) would like to learn more about it. Most nurses reported providing oral care at least two times daily using various methods and products such as suction toothbrush (90·4%), manual toothbrush (49·5%), cotton swab (91·5%) and foam swab (65·7%). Chlorhexidine gluconate oral rinse was the preferred mouthwash (97·8%) and swabs (93·5%) solution although few used non-optimal products such as sodium bicarbonate (14·0%), tap water (4·3%) and hydrogen peroxide (3·2%) to wash their patients' mouths. While the majority of nurses agreed that oral care supplies and equipments were available (93·6%) and suitable (88·2%), most of them also thought they need better hospital support (88·2%). CONCLUSIONS The nurses' attitudes towards oral care were generally positive and most oral care methods were appropriate. However, some methods and products used were inconsistent with the current recommendations and they have mixed views about the suitability of oral care supplies and equipment provided by the hospital. RELEVANCE TO CLINICAL PRACTICE Recommendations were made for providing standard oral care protocols for intubated patients and oral care training programs for ICU nurses to support delivery of quality patient care.
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Affiliation(s)
- Norkhafizah Saddki
- School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | | | - Mon Mon Tin-Oo
- School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Sousa LLA, e Silva Filho WLS, Mendes RF, Moita Neto JM, Prado Junior RR. Oral health of patients under short hospitalization period: observational study. J Clin Periodontol 2014; 41:558-63. [PMID: 24617503 DOI: 10.1111/jcpe.12250] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the impact of hospitalization on the oral health status of individuals hospitalized for a short period of time. MATERIAL AND METHODS This was an observational study of hospitalized patients. The plaque index (PI), gingival index (GI) was measured at baseline (T0 - first 24 h of hospital admission), and at 3 (T1), 7 (T2), 14 (T3) days. RESULTS One hundred and sixty-two patients were examined at baseline (T0), 35 examined at 3 days (T1), 23 at 7 days (T2) and 16 at 14 days (T3). The main reason for loss of patients was hospital discharge. The mean PI increased at T1 (0.97-1.21; p < 0.001), at T2 (1.06-1.30; p < 0.007) and at T3 (1.19-1.44; p < 0.03). Gingival index (GI) increased at T2 (0.74-0.96; p < 0.04) and at T3 (0.74-0.96; p < 0.02). CONCLUSION Oral health, assessed through PI and GI, deteriorates after a short period of hospitalization.
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Affiliation(s)
- Lucas L A Sousa
- Postgraduation Program in Dentistry, Federal University of Piauí (UFPI), Teresina, Brazil
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