Avaliação do protocolo de higiene bucal nos pacientes em Unidade de Terapia Intensiva

Abstract

Since suffering relief is a key component of care for all patients in the Intensive Care Unit regardless of condition and prognosis, evidence-based approaches to evaluation and treatment, coupled with well-designed work systems, can help ensure comfort in these patients. The objective of this study was to evaluate, before and after the application of an oral care protocol, the positive impact of this on patients in coronary ICU and to propose a systemic dental care protocol. Thirty-five patients, who were conscious and with natural breathing undergoing hospitalization, were evaluated. Medical history was obtained from medical records. Systematic dental assessment included intra-oral clinical examination, periodontal status, evaluation of salivary flow, with and without stimulation, assessment of dental complaints and symptoms, and oral health-related quality of life was investigated using the Oral Health Impact Profile (OHIP- 14). The descriptive statistics were presented through the mean and standard deviation and absolute and relative frequencies. In the comparison between averages, the effect size was evaluated by Cohen's d, and the following classification was adopted: small 0.20-0.49, moderate 0.50-0.79 and elevated ≥0.80. The mean age of the patients was 63.94 years. The majority was male, white, married, retired, received a low-sodium diet in the ICU and presented a history of previous hospitalizations. The mean length of stay in the ICU was 7.05 days. In the intra-oral evaluation, 10 patients were edentulous, 24 used prostheses and 100% of them were without hygiene. The most common gingival index was 2, which corresponds to gingiva with moderate inflammation and bleeding at the probe. The mean plaque index was 27.8. In the assessment of salivary flow, patients presented values compatible with hyposalivation. The mean value for OHIP-14 was 2.2, highlighting the negative impact of oral health on psychological incapacity and functional limitation. At the time of the evaluation, only 3 patients (8.57%) spontaneously presented a dental complaint. Despite this, other symptoms were evidenced through the applied questionnaires: dentin sensitivity, halitosis, xerostomia and symptoms of Temporomandibular Disorder. After application of the protocol, a positive impact of a high magnitude was observed in the reduction of the oral health impact on the quality of life, increase in the amount of saliva, reduction of dryness of the mouth and lip and increase of the salivary flow. The study demonstrated an improvement in the clinical condition of the patients evaluated after applying the oral care protocol, as well as improving the quality of life, evidencing the importance of the dentist in the hospital environment.