This term, widely used in intensive care units (ICUs) has gained prominence in recent months because of coronavirus infection (COVID-19).
Patients are faced down on their hospital bed in practice, known as pruning.
This change in the position is often enough to improve lung functionality and reduce the impact of respiratory distress caused by covid-19.
Proning — or placing a patient face-down — minimizes the effects of gravity on the lungs.
Putting the patient with the belly down helps increase the ability to use the lungs to absorb more oxygen. In this position, the heart no longer weighs heavily on the lung tissue but instead rests against the sternum.
As a result, lung tissue at the back of the thoracic cavity is relieved of the burden of gravity and is more capable of expansion and gas exchange.
In COVID-19, severe patients with Respiratory Distress Syndrome (RDS) have important dysfunction of the gas exchange made by the lungs.
A primary position is an important tool for improving these exchanges, being a viable option in the treatment since gas exchange would be facilitated. As a result, the patient would improve the oxygenation levels of the body, a fact observed in about 70% to 80% of patients with RDS.
How can dentistry assist patients in prone position?
The patient can be in a prone position for 18 hours per day, even with disabilities, oral hygiene still can be done.
To perform this procedure, the multidisciplinary team must be very well trained as constant manoeuvres are necessary to avoid injuries that may occur, due to the long stay of the patient in the same position.
In the orofacial region, it is very frequent the appearance of lesions in the mentum, cheeks, nose, lips, vestibular mucosa and dental traumas.
Before we carried out any mouth care it was important to ensure that the endotracheal tube cuff was inflated to prevent aspiration, and it was important to note how far the endotracheal tube was in the mouth.
The following recommendations were made for mouth care for proned patients:
Carry out tooth brushing at least once a day ideally with a disposable toothbrush. Try and brush all surfaces of the teeth.
- Avoid using electric toothbrushes as they generate more aerosol spray.
- Use a small-headed toothbrush with a long handle for better access.
- Use a smear of toothpaste or a non-foaming toothpaste on a dry toothbrush to prevent the build-up of secretions.
- Carry out gentle oral suctioning or use a single-use suction toothbrush.
- Try to stand to the side of the patient or behind them so your face is not directly in front of their face.
- Carry out dry mouth care regularly by moistening the mouth with water or using a dry mouth gel on a toothbrush as needed
- Gently brush the tongue in a forward sweeping action.
- Make sure the lips are regularly lubricated with a lip balm or water-based gel.
The prone is a technique that can save lives. However, applying the necessary care is essential to mitigate the sequels of a disease that has left many marks. Especially the emotional one.
Dr Adriana Figueiredo Flato
Oral hygiene is the practice of keeping the mouth, teeth and gums clean and healthy. It is the best way to prevent tooth decay, gingivitis and periodontists, as well as avoiding halitosis. The preventive care should be daily to avoid several problems with your oral health and well-being.
Oral hygiene and periodic consultations with your dentist are very important throughout your lifetime. Regardless of age, it is possible to have healthy teeth and gums if you brush your teeth at least three times a day, using adequate toothpaste. Don’t forget to floss at least once a day, and is important visit your dentist for check-ups.
Regardless of age, it is possible to have healthy teeth and gums
According to the World Health Organization (WHO), oral health comprises a state in which the person is free from pain, discomfort and changes in the mouth and face. This includes conditions of oral or throat cancer, infections and mouth ulcers, diseases and any disorders that may affect the quality of life, preventing the patient from eating, smiling, speaking or feeling socially comfortable.
Oral health directly reflects on overall health. It is through the mouth that the digestive process begins, as teeth are important for chewing food, the articulation of words and aesthetics.
Remember, early detection and treatment of problems with your gums, teeth and mouth can help ensure a lifetime of good oral health.
Oral hygiene advice:
From the earliest months of life, proper oral hygiene should be practiced.
For babies, soak gauze in filtered water and gently wipe the baby’s gums at least once a day, preferably at dusk, before the baby sleeps. After 6 months, an appropriate finger brush for the baby’s oral hygiene should replace the gauze. When the baby is 1 1/2 years old, parents should begin using a child’s toothbrush as well as using an age-appropriate, usually fluoride-free, toothpaste.
All these procedures should be part of the child’s routine early on, so that in the future, they see tooth brushing as normal routine.
- In addition to daily brushing and flossing, consider using mouthwash containing fluoride to promote oral health.
- Resist the temptation to use toothpicks or other objects that could injure your gums and let in bacteria.
- If you smoke, try to quit. Using tobacco increases your risk of many diseases, including gum disease and tooth loss
- Visit your dentist regularly – at least every 6 months to maintain good oral health.
Original text by:
Dr. Amanda Martins – CRO: 107.190 – Brazil / São Paulo
The importance of dental floss
Many people believe that just brushing their teeth after each meal is enough to keep their oral hygiene. What most people don’t know is the floss is not an accessory, but an indispensable item for complete tooth cleaning.
Dental floss, as well as your toothbrush, should be part of your daily oral cleaning routine to help eliminatee the dirt that accumulates during the course of our day.
The thread passed between the tooth and the gum eliminates the accumulation of plaque, especially those that cause caries and gingivitis.
Your regular toothbrush is essential to clean the surface of the teeth but is not enough to ensure cleanliness between them. Dental floss helps to clean between teeth, removing the remains of food that gets stuck and left behind.
Flossing is essential to prevent gingivitis and other diseases. The leftover food that accumulates in the gum below the visible part of the tooth becomes food for various bacteria which end up causing inflammation that can compromise your oral health.
In addition to preventing disease, flossing helps maintain better mouth aesthetics. By cleaning thoroughly, removing bacteria and food debris, floss helps preserve tooth enamel, making it stronger and resistant.
How to floss correctly?
- You will need about 40 cm of string
- Wrap the string around each middle finger
- Holding the thread between your thumb and forefinger, slide it with a movement from top to bottom, covering the entire the region between the gum and the teeth
- Slide carefully, to avoid damaging the gum, which is already a fragile tissue
- For each tooth to be cleaned it is necessary to use a new part of the dental floss
When removing dental floss from your teeth, always remember to move backwards.
Are you ready to floss?