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Pneumonia and the role of dentistry on ICU Staff


Respiration, artificial
Pneumonia, ventilator-associated

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Bezerra TP, Campêlo CS de P, Oliveira FAF, Forte CPF, Palácio Gomes AK, Barros Silva PG de, et al. Pneumonia and the role of dentistry on ICU Staff: 8-year analysis of health indicators. Braz. J. Oral Sci. [Internet]. 2020 Nov. 4 [cited 2024 Jul. 25];19:e200436. Available from:


Ventilator-associated pneumonia (VAP) is one ofthe most prevalent healthcare-associated infections (HAI) andcauses of death in intensive care units (ICUs), and studies haveshown its relation to oral health. Aim: To report the impact ofthe incorporation of dental professionals into multidisciplinaryICU staff on the incidence of VAP. Methods: A retrospectiveobservational study was carried out to collect and analyzehealth indicators of patients in the ICUs from 2011 to 2018 andto differentiate these indicators between the periods beforeand after the participation of dental staff in the ICU. This studywas approved by the Research Ethics Committee. Results:The average number of monthly ICU admissions was 105.89 ±169.72, and the discharge was 105.21 ± 168.96, with a monthlyaverage number of deaths within 24 h of 38.61 ± 62.27. Theaverage number of monthly HAI-related deaths decreasedfrom 2011 to 2018, followed by a reduction in cases of HAIper month. The average monthly number of HAIs relatedto mechanical ventilation (MV) decreased, and the samewas observed for the infection density of HAIs related to MV(p < 0.001). In multivariate analysis, there was a significantdecrease in the number of HAIs related to MV (p = 0.005).Conclusion: Although a reduction in the number of admissionsor complexity of cases was not observed in the study period,multidisciplinary staff practices were essential for controllingHAIs and the presence of dental professionals can assist in thecontrol of HAIs related to MV.


- do Nascimento ER, Trentini M. [Nursing care at the intensive care unit (ICU): going beyond objectivity]. Rev Lat Am Enfermagem. 2004 Mar-Apr;12(2):250-7. Portuguese. doi: 10.1590/s0104-11692004000200015.

- Munro CL, Grap MJ, Sessler CN, Elswick RK Jr, Mangar D, Karlnoski-Everall R, et al. Preintubation application of oral chlorhexidine does not provide additional benefit in prevention of early-onset ventilator-associated pneumonia. Chest. 2015 Feb;147(2):328-34. doi: 10.1378/chest.14-0692.

- Gomes SF, Esteves MCL. [Role of the surgeon dentist in ICU: a new paradigma]. Rev Bras Odontol. 2012;69(1):67-70. Portuguese.

- Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014 Aug;35(8):915-36. doi: 10.1086/677144.

- Lorente L, Lecuona M, Jiménez A, Palmero S, Pastor E, Lafuente N, et al. Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial. Eur J Clin Microbiol Infect Dis. 2012 Oct;31(10):2621-9. doi: 10.1007/s10096-012-1605-y.

- Koeman M, van der Ven AJ, Hak E, Joore HC, Kaasjager K, de Smet AG, Ramsay G, Dormans TP, Aarts LP, de Bel EE, Hustinx WN, van der Tweel I, Hoepelman AM, et al. Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med. 2006 Jun 15;173(12):1348-55. doi: 10.1164/rccm.200505-820OC.

- Wang J, Liu KX, Ariani F, Tao LL, Zhang J, Qu JM. Probiotics for preventing ventilator-associated pneumonia: a systematic review and meta-analysis of high-quality randomized controlled trials. PLoS One. 2013 Dec 18;8(12):e83934. doi: 10.1371/journal.pone.0083934.

- Needleman IG, Hirsch NP, Leemans M, Moles DR, Wilson M, Ready DR, et al. Randomized controlled trial of toothbrushing to reduce ventilator-associated pneumonia pathogens and dental plaque in a critical care unit. J Clin Periodontol. 2011 Mar;38(3):246-52. doi: 10.1111/j.1600-051X.2010.01688.x.

- Özçaka Ö, Başoğlu OK, Buduneli N, Taşbakan MS, Bacakoğlu F, Kinane DF. Chlorhexidine decreases the risk of ventilator-associated pneumonia in intensive care unit patients: a randomized clinical trial. J Periodontal Res. 2012 Oct;47(5):584-92. doi: 10.1111/j.1600-0765.2012.01470.x.

- Charles MP, Easow JM, Joseph NM, Ravishankar M, Kumar S, Sivaraman U. Aetiological agents of ventilator-associated pneumonia and its resistance pattern - a threat for treatment. Australas Med J. 2013 Sep 30;6(9):430-4. doi: 10.4066/AMJ.2013.1710.

- American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005 Feb;171(4):388-416. doi: 10.1164/rccm.200405-644ST.

- Alhazzani W, Smith O, Muscedere J, Medd J, Cook D. Toothbrushing for critically ill mechanically ventilated patients: a systematic review and meta-analysis of randomized trials evaluating ventilator-associated pneumonia. Crit Care Med. 2013 Feb;41(2):646-55. doi: 10.1097/CCM.0b013e3182742d45.

- DeKeyser Ganz F, Fink NF, Raanan O, Asher M, Bruttin M, Nun MB, Benbinishty J. ICU nurses' oral-care practices and the current best evidence. J Nurs Scholarsh. 2009;41(2):132-8. doi: 10.1111/j.1547-5069.2009.01264.x.

- Laupland KB, Zygun DA, Doig CJ, Bagshaw SM, Svenson LW, Fick GH. One-year mortality of bloodstream infection-associated sepsis and septic shock among patients presenting to a regional critical care system. Intensive Care Med. 2005 Feb;31(2):213-9. doi: 10.1007/s00134-004-2544-6.

- AMARAL SM, CORTES AQ, PIRES FR, Pneumonia nosocomial: importância do microambiente oral. J Bras Pneumol. 2009;35(11)1116-24. doi: 10.1590/S1806-37132009001100010.

– Matos FZ, Porto NA, Caporossi LS. Semenoff TADV, Borges AH, Segundo AS. Hospital Physicians’ knowledge of oral hygiene and oral manifestations in hospitalized patients. Pesq Bras Odontoped Clin Integr. 2013;13(3):239-43. doi: 10.4034/PBOCI.2013.133.03.

- de Souza IS, Santaella NG, da Silva Santos PS. The practice of hospital dentistry in Brazil: an integrative literature review. Rev Bras Odontol. 2017;74(3):232-9. doi: 10.18363/rbo.v74n3.p.232.

- Fourrier F, Dubois D, Pronnier P, Herbecq P, Leroy O, Desmettre T, Pottier-Cau E, Boutigny H, Di Pompéo C, Durocher A, Roussel-Delvallez M; PIRAD Study Group. Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: a double-blind placebo-controlled multicenter study. Crit Care Med. 2005 Aug;33(8):1728-35. doi: 10.1097/01.ccm.0000171537.03493.b0.

- Bergan EH, Tura BR, Lamas CC. Impact of improvement in preoperative oral health on nosocomial pneumonia in a group of cardiac surgery patients: a single arm prospective intervention study. Intensive Care Med. 2014 Jan;40(1):23-31. doi: 10.1007/s00134-013-3049-y.

- Bellissimo-Rodrigues WT, Menegueti MG, Gaspar GG, de Souza HCC, Auxiliadora-Martins M, Basile-Filho A, et al. Is it necessary to have a dentist within an intensive care unit team? Report of a randomised clinical trial. Int Dent J. 2018 Dec;68(6):420-7. doi: 10.1111/idj.12397.

- Tuon FF, Gavrilko O, Almeida S, Sumi ER, Alberto T, Rocha JL, et al. Prospective, randomised, controlled study evaluating early modification of oral microbiota following admission to the intensive care unit and oral hygiene with chlorhexidine. J Glob Antimicrob Resist. 2017 Mar;8:159-63. doi: 10.1016/j.jgar.2016.12.007.

- Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, Ng L, Worthington HV, Needleman I, Furness S. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2013 Aug 13;(8):CD008367. doi: 10.1002/14651858.CD008367.pub2. Update in: Cochrane Database Syst Rev. 2016 Oct 25;10 :CD008367.

- Scannapieco FA, Yu J, Raghavendran K, Vacanti A, Owens SI, Wood K, Mylotte JM. A randomized trial of chlorhexidine gluconate on oral bacterial pathogens in mechanically ventilated patients. Crit Care. 2009;13(4):R117. doi: 10.1186/cc7967.

- Prasad R, Daly B, Manley G. The impact of 0.2% chlorhexidine gel on oral health and the incidence of pneumonia amongst adults with profound complex neurodisability. Spec Care Dentist. 2019 Sep;39(5):524-32. doi: 10.1111/scd.12414.

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