Oral normality alterations and the impact on pneumonia, sepsis, and bloodstream infections in critically ill patients: a prospective cohort study

OBJECTIVE: To determine the prevalence of oral alterations among critical patients within the first 48 hours of intensive care unit admission, and their association with hospital-acquired pneumonia, bloodstream infections, and sepsis. METHODS: This prospective cohort study was conducted from March 2018 to December 2021 in a Brazilian neurology intensive care unit. A single dental surgeon assessed oral conditions with follow-up until hospital discharge. Logistic regression analyzed the association between oral alterations and outcomes (hospital-acquired pneumonia, bloodstream infections, and sepsis), adjusting for confounders. RESULTS: We enrolled 248 patients (55.6% male; mean age, 67.2 years), of whom 97.6% had oral abnormalities. The most common were visible dental plaque (61.7%), gingival inflammation (60.9%), and five or more missing teeth (49.2%). Carious teeth were linked to pneumonia (OR 1.10; 95%CI 1.00 - 1.20; p = 0.047). Destroyed teeth (OR 1.12; 95%CI 1.02 - 1.23; p = 0.02) and visible plaque (OR 1.08; 95%CI 1.00 - 1.17; p = 0.04) were associated with bloodstream infections. No factors were linked to sepsis. CONCLUSION: Most patients exhibited oral alterations upon admission to the intensive care unit. Carious teeth may increase pneumonia risk, while destroyed teeth and visible plaque may raise bloodstream infection risk.