According to the 2021 census, Portugal has a population of just over 10 million, with seniors over the age of 65 representing 23.4% of the population. We know in the same document that the aging rate is 182.1 (per 100 young people), and is associated with a negative growth rate.[1]. These indicators lead to an inescapable truth: we are an aging country! The demographic framework described previously is more present in Portuguese hospitals: these people contributed to almost half of the country’s hospitalizations, if we remove the number of births and newborns hospitalized.[2]. With age, the oral cavity undergoes various changes. If we adopt the WHO definition of “oral health”.” (A condition in which there is no pain in the mouth or face, neoplastic or other lesions of the mucous membrane of the mouth or throat, birth defects, gum disease, cavities, loss of teeth or other conditions affecting the oral cavity)[3] We quickly came to the conclusion that a large proportion of hospitalized older adults had compromised oral health.
The balance between oral health and disease has been explained by the eubiosis-dysbiosis hypothesis, which suggests that an oral tumor can change from a healthy state to a disease state, with destructive interactions between host and pathogenic microorganisms. There are several factors that can contribute to this dysfunction: clinical factors such as systemic diseases, cognitive problems that can make communication and oral care difficult, as well as physical problems that can present barriers to independence. The oral cavity serves as the primary point of human interaction with the external environment, through its main functions: chewing, tasting, speaking, and swallowing.[4],[5] Oral cavity hygiene is an important care to maintain the comfort and integrity of the oral mucosa, in addition to helping to control oral-related diseases.[6]
In hospitalized subjects, 48 hours after admission, it is estimated that the oral flora is colonized by microorganisms with high virulence, which, associated with inadequate or lack of hygiene, lead to the formation of biofilms (plaque) and resulting complications, Such as pain and infection[7]. Although no pathogenic microorganisms are associated with the early stages of periodontitis, the bacterial load and amount of plaque present, as well as its maturation, have been associated with the severity of the disease.
A variety of oral hygiene procedures have been advocated to remove dental plaque, with brushing with toothpaste being the first line and most recommended. Evidence supports that techniques such as conventional brushing with fluoridated toothpaste and the use of oral antiseptics improve gingivitis and reduce plaque rates, as long as brushing is sufficiently thorough and performed at appropriate intervals. Although the frequency and duration of brushing are not yet fully understood, there is consensus to recommend brushing twice daily with fluoridated toothpaste, for two minutes. Therefore, frequent oral hygiene is an important technique to control the microbial load in the teeth and oral cavity, to prevent oral and systemic infections.[8].
According to an integrative review of the bibliography, oral care, which includes oral hygiene, is underappreciated in hospital admissions, with justifications for not performing it being insufficient time to provide this care, lack of specific materials, lack of training and lack of protocols guiding good practice.[9],[10]. Therefore, there is a lot of work to be done, and a lot of oral care to be done by everyone and for everyone.
(This article is not intended for patient populations hospitalized in intensive care, on invasive mechanical ventilation and non-invasive ventilation.)
[1] https://www.pordata.pt/Tema/Portugal/Popula%c3%a7%c3%a3o-1
[2] Anna Oliveira. Master’s thesis: Hospitalizations of the population over 65 years of age in Portugal – Descriptive analysis. Universidad Nova de Lisboa, National School of Public Health, 2016
[3] Global Health Organization. oral health, https://www.who.int/health-topics/oral-health#tab=tab_1
[4] Kane, SF (2017) Effects of oral health on systemic health. General dentistry. November/December 2017, 30-34.
[5] Martin, K. Johnston, L.; Archer, N. (2020). Oral conditions in the community patient: Part 2 – Systemic complications of poor oral health. British Journal of Community Nursing November 2020, Volume 25, Issue 11
[6] MacNeil, B. A., & Sorenson, H. M. (2009). Oral hygiene of the ventilated patient. AARC Times Magazine, Volume 15.
[7] Karen K., Giuliano, K.K.; Pennoyer, D., Middleton, A. (2021). Oral care as prevention of non-ventilator hospital-acquired pneumonia: a four-unit cluster-randomized study. American Journal of Nursing Volume 121, Issue 6
[8] Alain Radek, Yvonne L. Oral capella and its dysbiosis: new insights into oral microbiome-host interactions, Journal of Computational and Structural Biotechnology, Volume 19, 2021, Pages 1335-1360, ISSN 2001-0370, https://doi. org/10.1016/j.csbj.2021.02.010.
[9] Joana Cabaz, Sonia Batista, Patricia Ribeiro. Oral care in older people: what is the controversies – an integrative literature review. https://revistas.rcaap.pt/servir/article/view/24495/18170
[10] Monroe, S.; Phillips, T.; Hasselbeck, R. Locatorto, M, A; Hehr, A. Sheila Ochielski, S. (2022). Implementation of oral care as a nursing intervention to reduce hospital-acquired pneumonia across the United States Department of Veterans Affairs health care system. doi: 10.1097/CIN.00000000000000808
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