Changes in dental plaque following hospitalisation in a critical care unit: an observational study

Abstract

IntroductionPrevious research has suggested that deterioration in oral health can occur following hospitalisation. The impact of such deterioration could increase the risk of oral disease, reduce quality of life and increase the potential for healthcare-associated infections (HCAI) such as healthcare-associated pneumonia (HAP). However, the strength of the evidence is limited by, amongst other factors, the few observational studies published that assess oral health longitudinally. In view of the microbiological component of oral diseases and HCAIs, the objective of this study was to investigate the microbiological changes in dental plaque following hospitalisation in a Critical Care Unit (CCU): (1) total number of cultivable bacteria and (2) presence and changes in specific HAP pathogens.MethodsWe conducted a prospective, longitudinal observational study in the CCU of University College Hospital, London. Study participants were recruited within 24 hours of admission. Dental plaque samples were collected from up to six sites per patient. The primary outcome was microbiological change from baseline to seven days with additional analysis for participants still present at day 14.Results50 patients were recruited with 36 available for review at one week, with early discharge accounting for much of the loss to follow-up. The median total viable count of the plaque microbiota at baseline was 4.40 × 105 cfu/ml and increased at week one to 3.44 × 106 cfu/ml. The total viable microbe counts increased by a median of 2.26 × 106 cfu/ml from baseline to week one (95% CI: 3.19 × 106, 1.24 × 107) and this was statistically significant (P < 0.01). Specific HAP bacteria were detected in 26% of participants sampled, although accounted for a relatively low proportion of the total viable bacteria.ConclusionTotal bacterial count of dental plaque increases during hospitalisation in CCU. This finding, together with the colonisation of dental plaque by HAP bacteria strengthens the evidence for a deterioration in oral health in CCU and a risk factor for negative health and quality of life outcomes.

Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study

“…38 However, there is considerable variability among critical care nurses on how oral care is delivered, with many choosing a foam swab in preference to a toothbrush, or neither method being used and relying on the application of antiseptic solutions or gels 1839 40 Almost all studies in critically ill patients have demonstrated that plaque scores increase even when oral care programmes are in place4 7–9 and it is therefore important to determine the optimal approaches to reduce plaque scores in mechanically ventilated patients 14…”

“…7–9 A number of interventions aimed at improving oral cleanliness have demonstrated a reduction in VAP or mortality in randomised clinical trials 10–13. However, these trials did not actually measure oral cleanliness and there has been a paucity of research conducted in mechanically ventilated patients on what represents the optimal methods for improving oral hygiene 14.…”

Association between pathogens from tracheal aspirate and oral biofilm of patients on mechanical ventilation

“…8,9 In addition, patients at intensive care units (ICUs) frequently exhibit poor oral hygiene, with substantial increase of the oral biofilm. 10 Ventilator-associated pneumonia (VAP) is an important cause of morbidity and mortality in ICUs. 11,12 Recent studies have suggested that VAP may be associated with microbial colonization of dental plaque and oropharynx; however, these evaluations were conducted with different methodologies and attained no conclusive results.…”

“…13,14 Significant levels of Staphylococcus aureus, Klebsiella pneumoniae and Enterobacter cloacae have also been found in the dental biofilm of ICU patients. 10 Due to the diversity of pathogens detected in the oral biofilm of patients with VAP, it is important to investigate which respiratory pathogens can colonize the oral biofilm of intubated patients in ICUs. Thus, the aim of this study was to explore possible associations between respiratory pathogens from tracheal aspirate and oral biofilm in intubated patients in an ICU and to identify the most common respiratory pathogens present in the oral biofilm, particularly in patients that develop VAP.…”

“…Some studies have shown a quantitative increase of pathogens that colonize the oral biofilm of patients in ICU with time. 10,25 However, the patients of this study had oral hygiene performed by trained nurse technicians under the supervision of a dentist, which might have decreased the reservoir of respiratory pathogens in the dental plaque between sample collections.…”