Systemic and oral health status of older adult inpatients in an intensive care unit / Avaliação da condição sistêmica e oral de idosos internados em uma unidade de terapia intensiva

Objective: To assess the systemic and oral health status of geriatric patients hospitalized in an intensive care unit (ICU). Methods: A cross-sectional descriptive study of a convenience sample of 78 older ICU inpatients. A single calibrated examiner collected demographic and clinical data by analyzing patients' records and assessing their oral cavities. Descriptive data analysis was performed to a 5.00% significance level. All patients provided informed consent and were conscious during the oral health assessment. Results: The mean age was 77.69 years and 51.28% of the sample were male. The main reasons patients were admitted to the ICU investigated were postoperative conditions (23.08%) and cardiac abnormalities (20.51%). Systemic arterial hypertension (69.23%) was the most prevalent comorbidity and patients were being treated with anticoagulants (57.69%) and antimicrobials (53.85%). Most patients did not receive oral care (64.10%), while 29.49% of them received it only once, and 57.69% were denture users. The mean decayed, missing, and filled teeth index was 23.74 (17.44 missing teeth, on average) and majorities had tongue biofilm (71.79%) and unsatisfactory oral hygiene during their time in hospital (84.62%). Conclusion: The oral status of hospitalized geriatric patients was characterized by poor hygiene and edentulism

Objetivos: Avaliar o estado de saúde sistêmica e oral de pacientes geriátricos internados em uma unidade de terapia intensiva (UTI). Metodologia: Estudo transversal descritivo, com amostra de conveniência de 78 idosos internados na UTI. Um único examinador calibrado coletou dados demográficos e clínicos, analisando os registros dos pacientes e avaliando as suas cavidades orais. A análise descritiva dos dados foi realizada com nível de significância de 5,00%. Todos os pacientes forneceram consentimento informado e estavam conscientes durante a avaliação da saúde oral. Resultados: A média de idade foi de 77,69 anos e 51,28% da amostra era do sexo masculino. Os principais motivos de internação dos pacientes na UTI investigados foram condições pósoperatórias (23,08%) e alterações cardíacas (20,51%). A hipertensão arterial sistêmica (69,23%) foi a comorbidade mais prevalente, e os pacientes estavam sendo tratados com anticoagulantes (57,69%) e antimicrobianos (53,85%). A maioria dos pacientes não recebeu cuidados orais (64,10%), enquanto 29,49% deles os receberam apenas uma vez e 57,69% eram usuários de próteses dentárias. O índice médio de dentes cariados, perdidos e obturados foi de 23,74 (17,44 dentes ausentes, em média) e a maioria apresentou biofilme lingual (71,79%) e higiene oral insatisfatória durante a internação (84,62%). Conclusão: A condição oral dos pacientes geriátricos hospitalizados foi caracterizada por má higiene e edentulismo.

Morphology and morphometry of the human sublingual glands in mouth floor enlargements of edentulous patients

Asymptomatic mouth floor enlargements may be observed in edentulous patients. These masses, which protrude from the mouth floor, may complicate the fitting of dentures and require surgery. Whether this "entity" may be considered an anatomical variation of the mouth floor or represent specific alterations in the sublingual gland is not known. Objective: The aim of this work is to investigate the morphological and morphometric aspects of the sublingual glands of edentulous patients with mouth floor enlargements and compare the glands of these patients with the sublingual glands of human cadavers. Material and Methods: Microscopic evaluation was performed on human sublingual glands from edentulous patients with mouth floor enlargements (n=20) and edentulous cadavers (n=20). The patients and cadavers were of similar ages. The data were compared using Mann-Whitney U, Fisher's exact and Student's t tests (p<0.05). Results: Acinar atrophy, duct-like structures, mononuclear infiltrates, replacement of parenchyma with fibrous/adipose tissue, mucous extravasation and oncocytosis were similar between the groups (p>0.05). Only the variables "autolysis" and "congested blood vessels" presented statistical difference between groups (p=0.014; p=0.043). The morphometric study revealed that the volume densities of acini, ducts, stroma and adipose tissue were similar between the groups (p>0.05). CONCLUSION: The microscopic characteristics of the sublingual glands in mouth floor enlargements in edentulous patients correspond to characteristics associated with the normal aging process. The glands are not pathological and represent an age-related alteration that occurs with or without the presence of the mouth floor enlargements. .

Comparação microscópica de glândulas sublinguais de cadáveres humanos e de pacientes desdentados portadores de tumefações do soalho da boca relacionadas às glândulas sublinguais: estudo morfológico e morfométrico / Microscopic comparative study of human cadaver sublingual glands and mouth floor enlargements related to the sublingual glands in edentulous patients: morphological and morphometric analysis

O soalho da boca de alguns pacientes desdentados parciais ou totais pode apresentar tumefações do soalho da boca relacionadas às glândulas sublinguais que dificultam a adaptação de próteses totais ou parciais, às vezes requerendo tratamento cirúrgico. Erroneamente, estas tumefações têm sido atribuídas à hiperplasia glandular. Alterações decorrentes do envelhecimento têm sido aventadas como possível causa, mas a etiopatogenia continua incerta. Na busca de explicar a causa das tumefações do soalho da boca de desdentados, foi elaborada a presente pesquisa. Foram comparadas microscopicamente as glândulas sublinguais de cadáveres humanos com glândulas removidas em tratamento cirúrgico pré-protético das tumefações do soalho da boca de desdentados. Estudo morfológico e morfométrico foram realizados em indivíduos de idades cronológicas semelhantes. Os resultados foram analisados com nível de significância de 5%. No estudo morfológico foram analisados: atrofia acinar (p=0,758), autólise acinar (p=0,014), infiltrado mononuclear focal (p=1,000) e difuso (p=0,142), substituição do parênquima por tecido fibroso (p=0,547), substituição do parênquima por tecido adiposo (p=0,547), extravasamento de muco focal (p=0,192) e difuso (p=0,758) e oncocitose (p=0,883). As variáveis ductos e/ou estruturas ductiformes (p=1,000) e vasos sangüíneos congestos (p=0,043) foram classificadas em ausentes e presentes. Morfometricamente foi determinada a densidade de volume de ácinos (p=0,752), ductos (p=0,444), estroma (p=0,209) e tecido adiposo (p=0,794). A análise dos resultados mostrou diferença estatisticamente significante para os aspectos microscópicos autólise (p=0,014) e vasos sanguíneos congestos (p=0,043). As características microscópicas das glândulas sublinguais nas tumefações do soalho da boca de desdentados retratam o processo normal de envelhecimento das glândulas salivares. Concluiu-se que nas tumefações do soalho da boca de pacientes desdentados as glândulas sublinguais não...

Mouth floor enlargements related to sublingual glands in edentulous or partially edentulous patients may be present, impairing denture fitting. Sometimes surgical treatment is needed. Erroneously, these enlargements have been attributed to glandular hyperplasia. Changes due to aging process have been suggested as a possible cause but the etiopathogenesis continues uncertain. The aim of the study was to explain the cause of mouth floor enlargements in edentulous patients. Human sublingual glands from necropsies and glands removed in pre-prosthetic surgical treatment of mouth floor enlargements in edentulous patients were microscopically compared. Morphological and morphometric studies were performed in individuals of similar chronological ages. Results were analyzed with significance set for p0,05. The morphological study analyzed: acinar atrophy (p=0,758), acinar autolysis (p=0,014), focal (p=1,000) and diffuse mononuclear infiltrate (p=0,142), replacement of parenchyma by fibrous tissue (p=0,547), replacement of parenchyma by adipose tissue (p=0,547), focal (p=0,192) and diffuse mucus overflow (p=0,758) and oncocytosis (p=0,883). The variables ducts and/or duct-like structures (p=1,000) and congested blood vessels (p=0,043) were classified in absent and present. The volumes densities of acini (p=0,752), ducts (p=0,444), stroma (p=0,209) and adipose tissue (p=0,794) were determined by the morphometric study. The results showed statically significant difference to the microscopic aspects: autolysis (p=0,014) and congested blood vessels (p=0,043). The microscopic aspects of the sublingual glands in mouth floor enlargements in edentulous patients revealed the normal aging process of the salivary glands. Concluding, the sublingual glands in mouth floor enlargements in edentulous patients are not pathological glands.