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Quintanilha RDMC, Pereira MRR, Oliveira SPD, Penoni DC, Salgado DR, Agostini M, Torres SR. Oral clinical findings and intensive care unit prognostic scores. BMJ Support Palliat Care 2023:spcare-2023-004479. [PMID: 37500568 DOI: 10.1136/spcare-2023-004479] [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] [Received: 07/06/2023] [Accepted: 07/09/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Hospitalisation in intensive care unit (ICU) may cause changes in oral environment, which may influence patients' health status. The aim of this study was to evaluate the frequency of intraoral and extraoral findings observed during ICU admission, and to verify if there is an association with clinical prognosis scores. METHODS Data regarding clinical characteristics of patients hospitalised in an ICU were collected from medical records. The prognostic scores Sepsis Related Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score (SAPS 3) were estimated with data collected from admission and SOFA on the day of the oral examination as well. Data on oral mucosa lesions, saliva, dental condition and oral hygiene were evaluated during oral examinations. RESULTS The association of oral findings with prognostic scores was statistically verified. The majority (92.2%) of the 170 evaluated patients showed extraoral or intraoral findings during ICU admission. The most frequent findings were chapped and crusted lips, coated tongue, pale mucosa, haemorrhagic lesions, candidiasis, depapillated tongue and traumatic lesions. There were significant higher prognostic scores in the presence of the following extraoral and intraoral findings: crusted and ulcerated lips, haemorrhagic lesions, jaundice, spontaneous oral bleeding, coated and depapillated tongue. Median SAPS 3 was higher in patients with poor oral hygiene. CONCLUSIONS Oral findings were frequent in the population of patients hospitalised in the ICU and some of them were associated with worse prognostic scores. Routine oral examinations must be performed in hospitalised patients from ICUs for detection of oral markers of worse clinical prognosis.
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Affiliation(s)
- Renata de Moura Cruz Quintanilha
- Department of Oral Pathology and Diagnosis, School of Dentistry, School of Dentistry, Universidade Federal do Rio de Janeiro - Rio de Janeiro, Brazil, Rio de Janeiro, Brazil
| | - Mara Regina Rocha Pereira
- Department of Oral Pathology and Diagnosis, School of Dentistry, School of Dentistry, Universidade Federal do Rio de Janeiro - Rio de Janeiro, Brazil, Rio de Janeiro, Brazil
| | - Silvia Paula de Oliveira
- Clementino Fraga Filho University Hospital, Universidade Federal do Rio de Janeiro- Rio de Janeiro, Brazil, Rio de Janeiro, Brazil
| | - Daniela Cia Penoni
- Department of Dental Clinic, School of Dentistry, Universidade Federal do Rio de Janeiro - Rio de Janeiro, Brazil, Rio de Janeiro, Brazil
| | - Diamantino Ribeiro Salgado
- Clementino Fraga Filho University Hospital, Universidade Federal do Rio de Janeiro- Rio de Janeiro, Brazil, Rio de Janeiro, Brazil
| | - Michelle Agostini
- Department of Oral Pathology and Diagnosis, School of Dentistry, School of Dentistry, Universidade Federal do Rio de Janeiro - Rio de Janeiro, Brazil, Rio de Janeiro, Brazil
| | - Sandra R Torres
- Department of Oral Pathology and Diagnosis, School of Dentistry, School of Dentistry, Universidade Federal do Rio de Janeiro - Rio de Janeiro, Brazil, Rio de Janeiro, Brazil
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Hihara H, Izumita K, Iwatsu M, Sato T, Tagaino R, Shobara K, Shinohara Y, Hatakeyama T, Kayaba C, Sato M, Tokue A, Sugawara T, Ashino K, Ikeda K, Aida J, Sasaki K. Clinical Trial for Evaluating the Effectiveness and Safety of a New Dental Plaque Removal Device: Microscale Mist Unit. Antibiotics (Basel) 2022; 11:antibiotics11060825. [PMID: 35740231 PMCID: PMC9219637 DOI: 10.3390/antibiotics11060825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 12/10/2022] Open
Abstract
This study evaluates the effectiveness and safety of a microscale mist unit (MSM-UNIT) that sprays high-speed fine water droplets to remove dental plaque adhering to the oral mucosa (tongue and palate) and tooth surface. Fifteen patients who had difficulty self-managing sufficient oral care were included in this study. Effectiveness was evaluated for at least five patients' tongues, palate mucosas, and tooth surfaces, and safety evaluation was conducted at all three sites for all patients. Effectiveness was evaluated using the rate of degree of dental plaque removal. Safety was evaluated using a numerical rating scale (NRS) for pain and symptoms of inflammation. An operator who performed treatment and an evaluator who evaluated effectiveness and safety were designated. In addition, an image judgment committee judged effectiveness. Although evaluation of the tongue varied between the evaluators and the image judgment committee, the rates of degree for all plaque removal increased in all regions. In addition, low pain NRS results and minimal symptoms of inflammation were observed and within an acceptable range. The MSM-UNIT can be used effectively and safely for removing oral plaque not only from teeth, but also from the oral mucosa.
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Affiliation(s)
- Hiroki Hihara
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; (M.I.); (T.S.); (R.T.); (K.S.); (Y.S.); (T.H.); (K.S.)
- Correspondence: ; Tel.: +81-22-717-8369
| | - Kuniyuki Izumita
- Perioperative Oral Health Management, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan;
| | - Misato Iwatsu
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; (M.I.); (T.S.); (R.T.); (K.S.); (Y.S.); (T.H.); (K.S.)
| | - Tomoya Sato
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; (M.I.); (T.S.); (R.T.); (K.S.); (Y.S.); (T.H.); (K.S.)
| | - Ryo Tagaino
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; (M.I.); (T.S.); (R.T.); (K.S.); (Y.S.); (T.H.); (K.S.)
- Perioperative Oral Health Management, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan;
| | - Kenta Shobara
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; (M.I.); (T.S.); (R.T.); (K.S.); (Y.S.); (T.H.); (K.S.)
| | - Yuta Shinohara
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; (M.I.); (T.S.); (R.T.); (K.S.); (Y.S.); (T.H.); (K.S.)
| | - Takanori Hatakeyama
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; (M.I.); (T.S.); (R.T.); (K.S.); (Y.S.); (T.H.); (K.S.)
| | - Chie Kayaba
- Department of Development Promotion, Clinical Research, Innovation and Education Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (C.K.); (M.S.); (A.T.); (T.S.); (K.A.); (K.I.)
| | - Mariko Sato
- Department of Development Promotion, Clinical Research, Innovation and Education Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (C.K.); (M.S.); (A.T.); (T.S.); (K.A.); (K.I.)
| | - Ayako Tokue
- Department of Development Promotion, Clinical Research, Innovation and Education Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (C.K.); (M.S.); (A.T.); (T.S.); (K.A.); (K.I.)
| | - Tomoko Sugawara
- Department of Development Promotion, Clinical Research, Innovation and Education Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (C.K.); (M.S.); (A.T.); (T.S.); (K.A.); (K.I.)
| | - Kanamai Ashino
- Department of Development Promotion, Clinical Research, Innovation and Education Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (C.K.); (M.S.); (A.T.); (T.S.); (K.A.); (K.I.)
| | - Koji Ikeda
- Department of Development Promotion, Clinical Research, Innovation and Education Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (C.K.); (M.S.); (A.T.); (T.S.); (K.A.); (K.I.)
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan;
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; (M.I.); (T.S.); (R.T.); (K.S.); (Y.S.); (T.H.); (K.S.)
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Lima JLDC, Alves LR, Paz JNPD, Rabelo MA, Maciel MAV, Morais MMCD. Analysis of biofilm production by clinical isolates of Pseudomonas aeruginosa from patients with ventilator-associated pneumonia. Rev Bras Ter Intensiva 2017; 29:310-316. [PMID: 28876402 PMCID: PMC5632973 DOI: 10.5935/0103-507x.20170039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/13/2017] [Indexed: 11/20/2022] Open
Abstract
Objective To phenotypically evaluate biofilm production by Pseudomonas
aeruginosa clinically isolated from patients with
ventilator-associated pneumonia. Methods Twenty clinical isolates of P. aeruginosa were analyzed, 19
of which were from clinical samples of tracheal aspirate, and one was from a
bronchoalveolar lavage sample. The evaluation of the capacity of P.
aeruginosa to produce biofilm was verified using two
techniques, one qualitative and the other quantitative. Results The qualitative technique showed that only 15% of the isolates were
considered biofilm producers, while the quantitative technique showed that
75% of the isolates were biofilm producers. The biofilm isolates presented
the following susceptibility profile: 53.3% were multidrug-resistant, and
46.7% were multidrug-sensitive. Conclusion The quantitative technique was more effective than the qualitative technique
for the detection of biofilm production. For the bacterial population
analyzed, biofilm production was independent of the susceptibility profile
of the bacteria, demonstrating that the therapeutic failure could be related
to biofilm production, as it prevented the destruction of the bacteria
present in this structure, causing complications of pneumonia associated
with mechanical ventilation, including extrapulmonary infections, and making
it difficult to treat the infection.
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Affiliation(s)
- Jailton Lobo da Costa Lima
- Programa de Pós-graduação em Medicina Tropical, Centro de Ciências da Saúde, Universidade Federal de Pernambuco - Recife (PE), Brasil
| | - Lilian Rodrigues Alves
- Programa de Pós-graduação em Medicina Tropical, Centro de Ciências da Saúde, Universidade Federal de Pernambuco - Recife (PE), Brasil
| | - Jussyêgles Niedja Pereira da Paz
- Programa de Pós-graduação em Medicina Tropical, Centro de Ciências da Saúde, Universidade Federal de Pernambuco - Recife (PE), Brasil
| | - Marcelle Aquino Rabelo
- Programa de Pós-graduação em Medicina Tropical, Centro de Ciências da Saúde, Universidade Federal de Pernambuco - Recife (PE), Brasil
| | - Maria Amélia Vieira Maciel
- Programa de Pós-graduação em Medicina Tropical, Centro de Ciências da Saúde, Universidade Federal de Pernambuco - Recife (PE), Brasil
| | - Marcia Maria Camargo de Morais
- Programa de Pós-graduação em Biologia Celular e Molecular Aplicada, Instituto de Ciências Biológicas, Universidade de Pernambuco - Recife (PE), Brasil
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4
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Souza LCD, Mota VBRD, Carvalho AVDSZD, Corrêa RDGCF, Libério SA, Lopes FF. Association between pathogens from tracheal aspirate and oral biofilm of patients on mechanical ventilation. Braz Oral Res 2017; 31:e38. [PMID: 28591237 DOI: 10.1590/1807-3107bor-2017.vol31.0038] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/10/2017] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to detect possible associations between respiratory pathogens from tracheal aspirate and oral biofilm samples in intubated patients in an intensive care unit (ICU), and to identify the most common respiratory pathogens in oral biofilm, particularly in patients that developed ventilator-associated pneumonia (VAP). Two oral biofilm samples were collected from the tongue of intubated patients (at admission and after 48 hours) and analyzed by culture with the Antibiotic Sensitivity Test. The results from the tongue biofilm samples were compared with the tracheal secretions samples. A total of 59.37% of patients exhibited the same species of pathogens in their tracheal aspirate and oral biofilm, of which 8 (42.1%) developed VAP, 10 (52.63%) did not develop pneumonia and one (5.26%) had aspiration pneumonia. There was a statistically significant association between presence of microorganisms in the tracheal and mouth samples for the following pathogens: Klebsiella pneumoniae, Candida albicans, Pseudomonas aeruginosa, Enterobacter gergoviae, Streptococcus spp and Serratia marcescens (p < 0.05). Pathogens that are present in tracheal aspirates of intubated patients can be detected in their oral cavity, especially in those who developed VAP or aspiration pneumonia. Thus, the results indicate that an improved oral care in these patients could decrease ICU pneumonia rates.
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Affiliation(s)
| | | | | | | | - Silvana Amado Libério
- Universidade Federal do Maranhão - UFMA, Department of Dentistry, São Luís,Maranhão, Brazil
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Erriu M, Pili FMG, Denotti G, Garau V. Black hairy tongue in a patient with amyotrophic lateral sclerosis. J Int Soc Prev Community Dent 2016; 6:80-3. [PMID: 27011938 PMCID: PMC4784070 DOI: 10.4103/2231-0762.175408] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Black hairy tongue (BHT) is a condition characterized by the elongation of filiform papillae associated with a marked discoloration, from yellowish-brown to black, and a thick lingual coating. BHT is usually observed in the elderly and in patients with limited self-sufficiency, as a consequence of poor oral hygiene. In this perspective, the patients affected by amyotrophic lateral sclerosis (ALS) represent a high-risk category for the occurrence of BHT. The fast and inexorable loss of their self-sufficiency due to progressive muscle atrophy as well as the impropriate education of healthcare assistants have demonstrated to have significant reflection on the maintenance of an adequate standard of oral hygiene. This paper firstly described a case of BHT in a patient affected by ALS. A case of BHT in a patient (Caucasic, male, 63 years old) affected by ALS was described. The primary goal of the work was to teach and motivate the patient to the use of the tongue cleaner in association with the local application of chlorexidine 0.20%. Furthermore, in order to support the patient with accurate domiciliary oral hygiene, a proper training for his health-care assistant was provided. The maintenance of the oral health of ALS patient is fundamental to prevent systemic complications that could jeopardize the already fragile physical balance of these patients. The dedicated monitoring by a dentist or a dental hygienist would seem essential in order to achieve this objective.
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Affiliation(s)
- Matteo Erriu
- Department of Surgical Science, Cagliari University, Cagliari, Italy
| | | | - Gloria Denotti
- Department of Surgical Science, Cagliari University, Cagliari, Italy
| | - Valentino Garau
- Department of Surgical Science, Cagliari University, Cagliari, Italy
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