The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 17 , ISSUE 10 ( October, 2016 ) > List of Articles


Periodontal and Microbiological Profile of Intensive Care Unit Inpatients

Mateus R Tonetto, Grace Rocatto, Fernanda Z Matos, FL Miranda Pedro, Suellen L Lima, AM Fabio Aranha

Citation Information : Tonetto MR, Rocatto G, Matos FZ, Pedro FM, Lima SL, Aranha AF. Periodontal and Microbiological Profile of Intensive Care Unit Inpatients. J Contemp Dent Pract 2016; 17 (10):807-814.

DOI: 10.5005/jp-journals-10024-1935

Published Online: 01-02-2017

Copyright Statement:  Copyright © 2016; The Author(s).



The bidirectional relationship between the periodontal diseases and systemic diseases was attributed to the focal infection concept. The aims of this study were to assess the periodontal and microbiological profile of intensive care unit (ICU) inpatients submitted to orotracheal intubation, and classify them regarding gender, age group, ethnic, hospitalization reason and period, nosocomial infection occurrence, and death.

Materials and methods

Inpatients were assessed, distributed into toothed and toothless groups. The periodontal clinical condition was assessed 24 hours after the ICU admission through plaque index, gum index, probing depth, and clinical level of insertion. All microbiological samples were collected on the 6th day of admission. These samples were collected from different intraoral sites, depending on the group: In the toothed group, samples were collected from gingival sulcus and in the toothless group, from buccal mucosa and tongue. Identification for Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Tannerella forsythia (Tf) was accomplished and analyzed, using absolute quantification and specific primer pairs through an amplification system with probes.


Forty subjects composed the sample: Gender characterized by 60% of male, 27.5% of all patients were older than 60, and 22.5% were hospitalized due to cerebrovascular accident. Regarding hospitalization period, 55% of patients were hospitalized for 6 days and 70% of them died during the period of hospitalization. Of inpatients, 40% presented periodontal disease and 100% presented dental biofilm on assessed sites. When assessing the microbiota, statistical significance was observed between Aa, Pg, and Tf, for both toothed and toothless group (p < 0.0001).


Large quantities of Aa were found in samples of toothless inpatients, a fact that suggests that the oral environment, even without teeth, presents favorable conditions for bacterial biofilm formation with a related pathogenic potential.

Clinical significance

The dental biofilm may comprise pulmonary pathogen colonies, promoting a perfect environment for their growth and development, facilitating the colonization of the lower airways, as well as colonization by bacteria originally from the oral cavity.

How to cite this article

Porto AN, Borges AH, Rocatto G, Matos FZ, Borba AM, Miranda Pedro FL, Lima SL, Tonetto MR, Bandéca MC, Aranha AMF. Periodontal and Microbiological Profile of Intensive Care Unit Inpatients. J Contemp Dent Pract 2016;17(10):807-814.

PDF Share
  1. Understanding the etiology of periodontitis: An overview of periodontal risk factors. Periodontology 2000 2003;32:11-23.
  2. Site-specific development of periodontal disease is associated with increased levels of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia in subgingival plaque. J Periodontol 2008 Apr;79(4):670-676.
  3. Defining the normal bacterial flora of the oral cavity. J Clin Microbiol 2005 Nov;43(11):5721-5732.
  4. Red bacterial complex is associated with the severity of chronic periodontitis in a Thai population. Oral Dis 2009 Jul;15(5):354-359.
  5. Periodontal diseases: Pathogenesis. Ann Periodontol 1996 Nov;1(1):821-878.
  6. Pneumonia in nonambulatory patients. The role of oral bacteria and oral hygiene. J Am Dent Assoc 2006 Oct;137(Suppl):21S-25S.
  7. Association between periodontal diseases and systemic diseases. Braz Oral Res 2008 Aug;22(Suppl 1):32-43.
  8. Epidemiology of nosocomial pneumonia. New perspectives on an old disease. Chest 1995 Aug; 108(Suppl 2):1S-16S.
  9. Role of oral bacteria in respiratory infection. J Periodontol 1999 Jul;70(7):793-802.
  10. Oral biofilms, periodontitis, and pulmonary infections. Oral Dis 2007 Nov;13(6):508-512.
  11. Relationships between periodontal disease and bacterial pneumonia. J Periodontol 1996 Oct;67(Suppl 10):1114-1122.
  12. Oral bacteria and respiratory infection: effects on respiratory pathogen adhesion and epithelial cell proinflammatory cytokine production. Ann Periodontol 2001 Dec;6(1):78-86.
  13. Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation. Clin Infect Dis 2008 Dec;47(12):1562-1570.
  14. Survey of oral care practices in US intensive care units. Am J Infect Control 2004 May;32(3):161-169.
  15. Systematic literature review of oral hygiene practices for intensive care patients receiving mechanical ventilation. Am J Crit Care 2007 Nov;16(6):552-562; quiz 563.
  16. Challenges in the culture-independent analysis of oral and respiratory samples from intubated patients. Front Cell Infect Microbiol 2014 May;4:65.
  17. Reproducibility of probing depth measurement using a constant-force electronic probe: analysis of inter- and intraexaminer variability. J Periodontol 2003 Dec;74(12):1736-1740.
  18. Problems and proposals for recording gingivitis and plaque. Int Dent J 1975 Dec;25(4):229-235.
  19. Detection of Actinobacillus actinomycetemcomitans in unstimulated saliva of patients with chronic periodontitis. J Periodontol 2005 Feb;76(2):204-209.
  20. Analysis of relative gene expression data using real-time quantitative PCR and the 2(-Delta Delta C(T)) method. Methods 2001 Dec;25(4):402-408.
  21. Natural history of dental plaque accumulation in mechanically ventilated adults: a descriptive correlational study. Intensive Crit Care Nurs 2011 Dec;27(6):299-304.
  22. Prevalence of Actinobacillus actinomycetemcomitans in Chinese chronic periodontitis patients and periodontally healthy adults. Quintessence Int 2009 Jan;40(1):53-60.
  23. Are putative periodontal pathogens reliable diagnostic markers? J Clin Microbiol 2009 Jun;47(6):1705-1711.
  24. Experimental gingivitis in man. J Periodontol 1965 May-Jun;36(3):177-187.
  25. Relationship between oral status and prevalence of periodontopathic bacteria on tongues of elderly individuals. J Med Microbiol 2010 Nov;59(Pt 11):1354-1359.
  26. Prevalence of Porphyromonas gingivalis and Bacteroides forsythus in chronic periodontitis by multiplex PCR. Pak J Biol Sci 2007 Nov;10(22):4123-4127.
  27. Acquisition and colonization stability of Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis in children. J Clin Microbiol 2000 Mar;38(3):1196-1199.
  28. Short-turn effect of full-mouth extraction on periodontal pathogens colonizing the oral mucous membranes. J Clin Periodontol 1994 Aug;21(7):484-489.
  29. Do elderly edentulous patients with a history of periodontitis harbor periodontal pathogens? Clin Oral Implants Res 2010 Jun;21(6):618-623.
  30. Prevalence of periodontal bacteria in saliva of Kuwaiti children at different age groups. J Infect Public Health 2010 May;3(2):76-82.
  31. Periodontal status in relation to age and tooth type. A cross-sectional radiographic study. J Clin Periodontol 1988 Aug;15(7):469-478.
  32. A radiographic survey of periodontal conditions in Greece. J Clin Periodontol 1995 May;22(5):385-390.
  33. Periodontal status in the United States, 1988-1991: Prevalence, extent, and demographic variation. J Dent Res 1996 Feb;75 Spec No:672-683.
  34. Probiotic prophylaxis of ventilator-associated pneumonia: a blinded, randomized, controlled trial. Am J Respir Crit Care Med 2010 Oct;182(8):1058-1064.
  35. Oral health status and development of ventilatorassociated pneumonia: a descriptive study. Am J Crit Care 2006 Sep;15(5):453-460.
  36. Exposure of P. gingivalis to noradrenaline reduces bacterial growth and elevates ArgX protease activity. Arch. Oral Biol., v. 56, n. 3, p. 244-50, Mar. 2011.
  37. Real-time polymerase chain reaction for detection and quantification of bacteria in periodontal patients. J. Periodontol., v. 76, n. 9, p. 1542-9, Sep. 2005.
  38. Efeito do laser de Diodo de 808nm como coadjuvante ao tratamento periodontal na redução de periodontopatógenos. 2009. Dissertação (Mestrado em Periodontia) – Faculdade de Odontologia, Universidade de São Paulo, São Paulo, 2009.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.