Association between bedside oral health status and severe acute respiratory syndrome in hospitalized adults: a cross-sectional study

Abstract

Hospitalized patients may experience oral health deterioration, particularly during acute respiratory illness. This study investigated the association between bedside oral health status and severe acute respiratory syndrome (SARS) in hospitalized adults. This cross-sectional study included 941 adults admitted to wards and intensive care units at two tertiary hospitals in São Luís, Brazil. The bedside oral examination was performed by a calibrated dentist within the first 24 h after hospital admission. SARS was defined according to the Brazilian Ministry of Health’s syndromic surveillance criteria. The primary exposure was oral health status assessed using the Bedside Oral Exam (BOE) and categorized as good, moderately impaired, or poor. Additional oral indicators included the Simplified Oral Hygiene Index, tongue coating, denture use, and oral lesions. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated using Poisson regression with robust variance. Of the 941 participants, 685 (72.8%) had SARS. In crude analyses, SARS status differed according to oral hygiene, tongue coating, denture use, and BOE classification. After multivariable adjustment, moderate oral health impairment (PR = 1.736; 95% CI: 1.524–1.976) and poor oral health status (PR = 2.097; 95% CI: 1.853–2.372) remained associated with a higher prevalence of SARS compared with good oral health. Associations with the individual oral indicators were attenuated in the extended model. Poorer bedside oral health status, as assessed by the BOE, was associated with a higher prevalence of syndromically defined SARS. The cross-sectional design precludes temporal or causal inference. The BOE may support screening for oral care needs during hospitalization, but the findings do not establish diagnostic superiority or predictive value.