Infectious Diseases Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
Int Dent J. 2018 Dec;68(6):420-427. doi: 10.1111/idj.12397. Epub 2018 May 18.
To evaluate the effectiveness of dental treatment in improving oral health in critical patients.
This randomised clinical trial was conducted in a general intensive care unit (ICU) at a tertiary care public facility from 1 January 2011 to 8 August 2013. Data from 254 adult patients staying in the ICU for 48 hours or more were analysed. The experimental group (n = 127) had access to dental treatment provided by a dentist four to five times a week, in addition to routine oral hygiene, whereas the control group (n = 127) had access only to routine oral hygiene, including topical application of chlorhexidine, provided by the ICU nursing staff. The baseline oral health status of the enrolled patients was poor and included edentulism, caries, gingivitis, periodontitis and residual roots. Dental treatment consisted of toothbrushing, tongue scraping, removal of calculus, scaling and root planing, caries restoration and tooth extraction.
The Oral Hygiene Index Simplified (OHI-S) and Gingival Index (GI) scores decreased in the experimental group but did not change significantly in the control group during the ICU stay. Dental treatment prevented most of the episodes of respiratory tract infections, as previously reported. No severe adverse events from the dental treatment were observed.
From an interprofessional perspective, our results support the idea of including dentists in the ICU team to improve oral health in critical patients and effectively prevent respiratory tract infections, in addition to the improvement achievable by applying chlorhexidine alone.
评估牙科治疗在改善危重症患者口腔健康方面的效果。
本随机临床试验于 2011 年 1 月 1 日至 2013 年 8 月 8 日在一家三级公立医院的综合重症监护病房（ICU）进行。对入住 ICU48 小时或以上的 254 名成年患者的数据进行了分析。实验组（n=127）除常规口腔卫生外，每周由牙医提供 4 至 5 次牙科治疗，而对照组（n=127）仅接受 ICU 护理人员提供的常规口腔卫生，包括局部应用洗必泰。纳入患者的基线口腔健康状况较差，包括无牙、龋齿、牙龈炎、牙周炎和残根。牙科治疗包括刷牙、刮舌、去除牙石、洁治和根面平整、龋齿修复和拔牙。
实验组的简化口腔卫生指数（OHI-S）和牙龈指数（GI）评分在 ICU 期间有所下降，但对照组无显著变化。正如先前报道的那样，牙科治疗预防了大多数呼吸道感染的发作。未观察到牙科治疗的严重不良事件。
从跨专业的角度来看，我们的结果支持在 ICU 团队中加入牙医的想法，以改善危重症患者的口腔健康，并有效预防呼吸道感染，而单独应用洗必泰可获得的改善效果则是次要的。
