Oral clinical findings and intensive care unit prognostic scores

Abstract

ObjectiveHospitalisation 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.MethodsData 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.ResultsThe 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.ConclusionsOral 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.

Assessment of oral changes in 2692 intensive care unit patients: a cross-sectional study

“…Mucosal dryness is a common nding in patients admitted to the ICU [10] and may be a consequence of reduced salivary ow and/or sialochemical changes secondary to medication use, stress, and dehydration [10,16,27]. In our sample, dry mouth accounted for 7.69% of oral changes.…”

“…Oral changes were identi ed and classi ed using an adaptation of the method proposed by Eduardo et al [14] based on their etiology: 1) Odontogenic infections -any change of endodontic and/or periodontal origin, including fractured teeth, residual tooth roots, and dentoalveolar abscesses of endodontic origin [6,10,15]. Gingivitis was de ned when the gingival margin and interdental papillae appeared swollen and red [6].…”

“…We observed dryness of the lip vermilion in 6.84% of the patients. In addition to causing pain, dry lips can represent a gateway for secondary infections when the skin barrier is damaged [5,10].…”

“…Most ICU patients exhibit oral lesions and infectious foci before admission, including dental caries, residual roots, periodontal disease, and gingivitis [6]. Furthermore, these patients may develop oral changes resulting from medication use secondary to systemic changes and/or ventilatory support, which can involve different tissues such as the mucosa, bones, teeth, and salivary glands [2,3,[7][8][9][10].…”

“…However, knowledge about the incidence of oral changes in ICU patients is limited [2,14]. Such studies are important since they provide reliable data on the main diagnoses that affect this population [6,10], in addition to contributing to the development of prevention and treatment strategies [14]. Considering the paucity of these data, the objective of the present study was to evaluate the incidence of oral changes and the demographic pro le of patients admitted to an ICU.…”