Department of Integrated Dentistry, Poznan University of Medical Sciences (PUMS), Bukowska st. 70, 60-812, Poznan, Poland.
Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences (PUMS), Szamarzewskiego 82/84, 60-569, Poznan, Poland.
Eur J Med Res. 2023 Aug 22;28(1):293. doi: 10.1186/s40001-023-01273-6.
The management of oral health during severe symptoms of Covid-19 is still a challenge, especially in intensive care units under invasive/noninvasive ventilation in hospital. Understanding the cause-and-effect relationships may allow for individual adjustment of oral care recommendations during Covid-19 disease. The study's objective was to assess Covid-19 patients' oral health status under hospital treatment due to pulmonary adverse Covid-19 outcomes.
Covid-19 patients (mean age 74.4 ± 15.4; n = 120, male n = 50/female n = 70) were admitted to hospital in the acute phase of Covid-19 between January and March 2022 who required oxygen therapy due to pneumonia, rapid respiratory failure, low saturation. Blood and radiological tests were taken according to National Health Fund guidelines. The condition of teeth (Decayed, Missing, Filled teeth as DMFT index), dental hygiene (Plaque Control Record as PCR index), periodontal status (probing depth PD, clinical attachment CAL, bleeding on probing BOP) and oral mucosa (BRUSHED and Beck scores) were examined.
Charateristics of the teeth (dental caries 35.2%, DMFT Median 22), plaque retention (83.4%), advanced periodontitis (48.3%), xerostomia (74.2%), oral mucosa inflammation (80.8%), angular cheilitis (53.3%), hemorrhagic (21.7%) showed a high incidence of harmful oral conditions. BRUSHED model and Beck score indicated moderate oral dysfunction and need for oral care every 8 h. Spearman's analysis revealed a significant positive correlation between pneumonia and neutrophile, interleukin-6 IL-6, C-reactive protein CRP (p = 0.01, p < 0.001, p < 0.001), negative to lymphocyte count (p < 0.001). Multiple and logistic regressions selected the following risk predictors for pneumonia as IL-6, CRP, obesity and for severe COVID-19 symptoms D-dimer level and a lack of targeted vaccination (p < 0.001). Among oral predictors, the PCR index and Beck score were significant for both outcomes (respectively p < 0.001, p < 0.012). Patients who received oxygen therapy with face masks had more often angular heilitis and debris (p = 0.025, p = 0.035).
COVID-19 hospitalised patients with severe symptoms crossing with poor oral health-related conditions. This may exacerbate a response for COVID infection, and play a role in cytokine storm. For Covid-19 management, to inhibit extraoral/intraoral complications, it is recommended to adjust oral hygiene procedures, including antibacterial, protective, moisturising agents after individual oral health assessment.
在新冠病毒感染的严重症状期间，口腔健康的管理仍然是一个挑战，尤其是在医院接受有创/无创通气的重症监护病房。了解因果关系可能允许在新冠病毒疾病期间对口腔护理建议进行个体化调整。本研究的目的是评估因肺部不良新冠病毒结局而在医院接受治疗的新冠病毒患者的口腔健康状况。
2022 年 1 月至 3 月期间，因肺炎、快速呼吸衰竭、低氧饱和度而需要氧疗的新冠病毒患者被收入院，这些患者处于新冠病毒感染的急性期。根据国家健康基金指南进行血液和放射学检查。检查牙齿状况（龋齿、缺失、填充的牙齿，即 DMFT 指数）、口腔卫生（菌斑控制记录，即 PCR 指数）、牙周状况（探诊深度 PD、临床附着 CAL、探诊出血 BOP）和口腔黏膜（BRUSHED 和 Beck 评分）。
牙齿特征（龋齿 35.2%，DMFT 中位数 22）、牙菌斑滞留（83.4%）、牙周炎进展（48.3%）、口干（74.2%）、口腔黏膜炎症（80.8%）、口角炎（53.3%）、出血（21.7%）表明存在有害口腔状况的高发生率。BRUSHED 模型和 Beck 评分表明口腔功能中度障碍，需要每 8 小时进行口腔护理。Spearman 分析显示肺炎与中性粒细胞、白细胞介素-6（IL-6）、C 反应蛋白（CRP）呈显著正相关（p=0.01、p<0.001、p<0.001），与淋巴细胞计数呈负相关（p<0.001）。多元和逻辑回归选择了以下肺炎风险预测因子：IL-6、CRP、肥胖和严重新冠病毒症状的 D-二聚体水平和缺乏靶向疫苗接种（p<0.001）。在口腔预测因子中，PCR 指数和 Beck 评分对两种结局均有意义（分别为 p<0.001、p<0.012）。接受面罩吸氧的患者更常出现口角炎和碎屑（p=0.025、p=0.035）。
患有严重症状的新冠病毒住院患者与口腔健康相关状况不佳有关。这可能会加剧对新冠病毒感染的反应，并在细胞因子风暴中发挥作用。为了抑制新冠病毒感染的口腔外/口腔内并发症，建议在进行个体口腔健康评估后，调整口腔卫生程序，包括使用抗菌、保护和保湿剂。
