Special Care in Dentistry

Retrospective analysis of dental care and the profile of

patients admitted to a burn unit

Journal: Special Care in Dentistry

Manuscript ID 5328

Wiley - Manuscript type: Original Article

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Keywords: hospital dentistry, quality of life, wound healing

Burn accidents pose a significant challenge to public health in Brazil,

affecting approximately 1,000,000 individuals annually, with a mortality
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rate of around 2500 patients. Patients hospitalized due to burns often

present oral complications, which is a scarcely explored aspect in the
literature. This retrospective study, conducted from January 2016 to
December 2022, analyzed electronic medical records of patients in a
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public hospital's burn unit. Of the 25 patients analyzed, with an average

age of 28 years, 13 were female and 12 were male. A total of 74 dental
appointments were conducted, demonstrating improvement in oral
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health indices between the initial and final assessments, as per the
Abstract: Bedside Oral Exam (BOE) index. Although 1.35% of patients did not
have the BOE recorded, the majority showed indicative improvement
indices, with notable positive outcomes after dental appointments. Burn
diagnoses varied, including areas within the scope of the dentist, such as
burns to the head and neck, as well as mouth and pharynx. The most
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recurrent burns were third-degree burns on an unidentified part of the

body (8.14%). Over the years, the dental service contributed to the
clinical evolution of patients, resulting in an increased demand for dental
professionals in the burn unit. Oral health indices showed improvements
after dental care, emphasizing the importance of oral care in burn
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victims.
Page 1 of 9 Special Care in Dentistry

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3 Retrospective analysis of dental care and the profile of patients admitted to a burn
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5 unit
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7 ABTRASCT
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Burn accidents pose a significant challenge to public health in Brazil, affecting
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10 approximately 1,000,000 individuals annually, with a mortality rate of around 2500
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12 patients. Patients hospitalized due to burns often present oral complications, which is
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14 a scarcely explored aspect in the literature. This retrospective study, conducted from
15 January 2016 to December 2022, analyzed electronic medical records of patients in a
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17 public hospital's burn unit. Of the 25 patients analyzed, with an average age of 28
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19 years, 13 were female and 12 were male. A total of 74 dental appointments were
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conducted, demonstrating improvement in oral health indices between the initial and
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22 final assessments, as per the Bedside Oral Exam (BOE) index. Although 1.35% of
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24 patients did not have the BOE recorded, the majority showed indicative improvement
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26 indices, with notable positive outcomes after dental appointments. Burn diagnoses
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varied, including areas within the scope of the dentist, such as burns to the head and
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29 neck, as well as mouth and pharynx. The most recurrent burns were third-degree burns
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31 on an unidentified part of the body (8.14%). Over the years, the dental service
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33 contributed to the clinical evolution of patients, resulting in an increased demand for
34 dental professionals in the burn unit. Oral health indices showed improvements after
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36 dental care, emphasizing the importance of oral care in burn victims.
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Keywords: Burn Units, Dental Taff, Burns, Oral Health.
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43 Introduction:
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45 Burns are defined as injuries caused by various factors, such as direct
46 contact with friction, cold, heat, radiation, chemicals, or electricity, with the majority
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48 originating from the heat of hot liquids, solids, or fire. In addition to the cause of the
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50 burn, its classification follows patterns of depth and extent, being termed first, second,
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and third degree. The World Health Organization (WHO) estimates that approximately
53 11 million burn injuries occur annually worldwide, resulting in 180,000 fatal cases. In
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55 Brazil, between 2015 and 2020, there were 19,772 deaths from burns, with 53.3% (n
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57 = 10,545) attributed to thermal burns, 46.1% (n = 9,117) to electrical burns, and 0.6%
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(n = 110) to other causes. Regarding the location of the burns, the face stands out,
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60 representing a significant challenge, as untreated burns can lead to important
 Special Care in Dentistry Page 2 of 9

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3 sequelae, requiring care, attention, and support available in specialized burn units.
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5 Patients with facial burns present local painful symptoms with significant emotional
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7 impact, factors that can interfere with clinical evolution. The recovery of these patients
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requires multidisciplinary care, aiming at health care and assistance, strengthening
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10 physical, psychological, and social aspects, including the role of the dentist in this
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12 context. Literature on the analysis of data from hospitalized burn patients has
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14 limitations, typical of retrospective analyses, with frequently incomplete data.
15 Additionally, there is an absence of a standardized recording system to report and
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17 document the severity of oral changes, which would be useful for correlating with
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19 various etiologies, similar to medical record systems. The objective of this study is to
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conduct a survey of data from burn patients who received dental care during
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22 hospitalization, characterize the profile of hospitalized patients, analyze oral health

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24 indices, and evaluate the frequency of dental appointments in the burn unit.
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Methodology:
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29 This is a retrospective cross-sectional study with a convenience sample,

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31 conducted through the survey of treated data from complete medical records indexed
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33 in digital files of a public hospital, regarding patients hospitalized in the burn unit who
34 received dental care from January 2016 to December 2022. A total of 25 medical
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36 records were included, which had as inclusion criteria all patients hospitalized in the
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38 burn unit who received care from the hospital's dental team. Complete demographic
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data were collected, including: sex, age, score of the Bedside Oral Exam (BOE),
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41 diagnosis of burn type according to the International Classification of Diseases (ICD),

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43 and records of the frequencies of dental appointments performed. Medical records with
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45 incomplete data were considered exclusion criteria. The assessment of the oral
46 condition indicator (BOE) was performed at the first and last dental appointment to
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48 evaluate the evolution of the condition after the establishment of interventions by the
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50 Hospital Dentistry team. Data were analyzed and organized in graphs and tables using
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Microsoft Excel (2013). A descriptive analysis of the data obtained was performed.
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57 Results:
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Patient data were tabulated, resulting in a total of 25 patients, with a mean
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60 age of 28 years, ranging from 0 to 70 years. Of the 25 analyzed medical records, 13
Page 3 of 9 Special Care in Dentistry

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3 (52%) belonged to females and 12 (48%) to males, showing no gender prevalence in
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5 this study. Based on the results of the oral condition indicator (BOE), an improvement
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7 in the clinical evolution of patients who received more than one dental appointment
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was observed, comparing initial and final indices. Most patients who received dental
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10 care showed a reduction in the oral condition index assessed by the BOE (Table 1).
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12 Among the 25 patients attended by the team, it was noted that the age group with the
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14 highest prevalence was between 40 and 49 years, followed by the age group of 20 to
15 29 years. The age groups with the lowest prevalence were those over 50 years (Graph
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17 1). From 2016 to 2022, 74 dental appointments were performed in the Burn Treatment
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19 Unit (BTU), requested by medical team consultation. A higher frequency of
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appointments was observed in the years 2018 and 2022 (Graph 2). Records of the oral
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22 condition indicators (BOE) made by dentists showed that most appointments had
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24 Scores 10 and 11, considered with few oral changes. Despite the majority having a
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26 regular oral health index, 10 of these patients had poor oral indicators (BOE), ranging
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from Score 14 to 18, classified as severe oral changes (Graph 3). The profile of
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29 patients, according to the description of diagnoses through the International

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31 Classification of Diseases (ICD) in the medical records of patients hospitalized in the
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33 Burn Treatment Unit (BTU), is shown in Graph 4. It was observed that most
34 appointments were for patients with third-degree burns in an unidentified part of the
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36 body, with extensive areas affected. Additionally, the presence of locoregional burns,
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38 such as head and neck, and burns of the mouth and pharynx, areas with greater
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involvement of the dentist, was observed (Graph 4).
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 Special Care in Dentistry Page 4 of 9

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4 Patient Age Gender BOE BOE
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6 Initial Final
7 1 21 M 9 -
8
9 2 30 F 15 14
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11 3 35 F 14 -
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13 4 27 F 12 11
14 5 45 M 12 9
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16 6 70 M 11 11
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18 7 0 F 16 15
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20 8 30 F 10 -
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9 46 M 13 11
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23 10 23 F 8
24
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25 11 22 M 10 9
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27 12 21 M 13 9
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13 44 F 10 -
30 14 13 F 10 9
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32 15 52 F 11 10
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34 16 46 F 11 10
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36 17 28 F 16 10
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37 18 12 M 16 10
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39 19 5 M 10 -
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20 43 M 18 11
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43 21 48 F 12 9
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22 47 F 13 -
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46 23 0 M 10 10
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48 24 34 M 10 9
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50 25 7 M 11 9
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54 Table 1. Data obtained from patients: age, gender, initial and final Beside Oral Exam
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56 (BOE) indices.
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Page 5 of 9 Special Care in Dentistry

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6 Age Range of Patients Treated
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8 35,00%
9 29,63%
30,00%
10 25,93%
11 25,00%
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13 20,00%
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15 15,00% ATENDIDOS
14,81% 14,81%

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17 10,00% 7,41%
18 3,70% 3,70%
5,00%
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20 0,00%
21 0-9 years 10-19 years 20-29 years 30-39 years 40-49 years 50-59 years over 60 years
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Series 1
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24
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28 Graph 1. Percentage of age range of treated patients in relation to the total number
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30 of appointments conducted.
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34 APPOINTMENT FREQUENCY/YEAR
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38 28,70% 28,30%
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42 18,90%
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45 12,10%
46 9,40%
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49 1,30%
50 0
51 2016 2017 2018 2019 2020 2021 2022
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55 Graph 2. Percentage of annual appointments in relation to the total number of
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appointments conducted from 2016 to 2022.
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 Special Care in Dentistry Page 6 of 9

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4 Appointment Frequency (%)
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30,00%
6 27,02%
7 25,67%
8 25,00%
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11 20,00%
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14 10,81% 10,81%
15,00%
15 10,00%
6,75%
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17 5,00% 4,05% 4,05% 4,05% 4,05%
18 1,30% 1,35%
19 0,00%
20 Without Score 8 Score 9 Score 10 Score 11 Score 12 Score 13 Score 14 Score 15 Score 16 Score 18
21 Score
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23 Appointment Frequency (%)
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Graph 3. Percentage frequency of dental care appointments for burned patients
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27 relative to the Overall Burned Patients (BOE), for the period from 2016 to 2022.
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Appointment frequency and Profiles
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33 Burns covering 39%, unspecified part of the body. 8.14%
34 Burns covering 10% or less of the body 7.40%
Burns covering 30-39% of the body 6.66%
35 Second-degree burns, unspecified part of the body 6.66%
36 Burns covering 20-29% of the body 5.92%
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37 Others 5.78%
38 Other burns 4.44%
39 Burns covering 50-59% of the body 4.44%
40 Burns covering 20-29% of the body 2.96%
Burns covering 40-49% of the body 2.22%
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41 Second-degree burns to the trunk 2.22%

42 Second-degree burns to the head and neck 1.48%
43 Burns to the mouth and pharynx 0.74%
44 Third-degree burns to the hip and lower limb,... 0.74%
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%

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48 Appointment frequency
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52 Graph 4. Profile of patients attended according to the description of the main ICD
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54 and its relationship with the quantity of appointments frequency conducted.
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57 Discussion
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Page 7 of 9 Special Care in Dentistry

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3 Burns are classified according to their extent, degree, and affected area, such as
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5 the head and neck region, where significant oral changes can be found. However,
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7 due to the lack of a standard recording system to report and document the severity
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of these alterations, it is necessary to use classification methods existing in the
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10 literature, such as the Bedside Oral Examination (BOE). This indicator has been
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12 frequently used as a measure of oral health for patients in the neuroscientific ICU.
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14 BOE total scores range from 8 (excellent oral health) to 24 (poor oral health). Based
15 on the results of the oral health indices in this study, it is evident that burn patients
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17 may experience oral changes, and dental follow-up for these patients results in a
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19 decrease in the oral health index, contributing to the evolution of the patient's oral
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and systemic health.
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24 Among the most serious and frequent complications in hospitalized burn patients,
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26 infection stands out. After hemodynamic and respiratory control, infection care
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becomes a significant challenge, being one of the leading causes of mortality and
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29 morbidity in these patients. This complicates the rotational presence of dentists in

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31 this environment, making it unfeasible to actively search for oral alterations in these
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33 patients. In this study, all appointments were made based on medical opinion and
34 upon request from the nursing team. Therefore, appointments are carried out
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36 according to the needs identified by the multidisciplinary team. The results highlight
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38 the importance of dental care in response to the team's requests, as most patients
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presented some alteration, requiring the intervention of the dentist.
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43 The Hospital Dentistry service was implemented in the hospital under study in
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45 2015. Despite the time elapsed, a reduction in appointments was observed between
46 2020 and 2021, justified by the Covid-19 pandemic. This atypical period resulted in
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48 new guidelines and adaptations in sector routines, leading to a decrease in dental
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50 appointments. Despite the challenges of interdisciplinary and multidisciplinary
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practice, the dentist has gained ground in the Burn Unit (BU), with the
53 implementation of specific actions that demonstrate positive results, promoting
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55 comprehensive health, prevention, and optimization of hospitalization time and cost.
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57 This contributed to increasing the medical team's knowledge about dental work in
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this context, generating more requests and opinions for the dental team, benefiting
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60 both patients and the multidisciplinary team.
 Special Care in Dentistry Page 8 of 9

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5 Through this retrospective study, a certain scarcity in the literature regarding dental
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7 care for burn patients was observed, with low casuistry, making it difficult to search
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for references in databases. It is hoped that this study will result in the emergence
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10 of new research, establishing diagnoses and creating guidelines for innovation and
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12 improvement in dental care for these patients.
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15 Conclusion
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17 It is concluded that according to the data obtained from the medical records
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19 of patients treated by the dentistry team at the hospital under study, there is a wide
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variety of types of burns in relation to their extent, degree, and affected area. It was
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22 observed that oral health indices improved when compared to the initial and final
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24 scores after dental care. It is evident that the multidisciplinary team understands the
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26 importance of dental care, which contributed to the frequency of appointments made
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according to the patient's needs.
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31 References
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34 1. Oliveira TS, Moreira KFA, Gonçalves TA. Nursing care for burn patients.
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36 Rev Bras Queimaduras. 2012;11(1):31-7.
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2. World Health Organization. Facts about injuries: burn. Available at:
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41 www.who.int/mipfiles/2014/burns1.pdf.
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43
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45 3. Ministry of Health (BR). Secretariat of Health Care. Department of
46 Specialized Care. Handbook for emergency treatment of burns. Brasília:
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48 Ministry of Health Publisher; 2012.
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50
51
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4. Hoogewerf CJ, van Baar ME, Hop MJ, Bloemen MC, Middelkoop E,
53 Nieuwenhuis MK. Burns to the head and neck: epidemiology and predictors
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55 of surgery. Burns. 2013;39(6):1184-92.
56
57
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5. Jeschke MG, van Baar ME, Choudhry MA, Chung KK, Gibran NS, Logsetty
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60 S. Burn injury. Nat Rev Dis Primers. 2020;6(1):11. Published 2020 Feb 13.
Page 9 of 9 Special Care in Dentistry

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3 doi:10.1038/s41572-020-0145-
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5
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7 6. Prendergast V, Kleiman C, King M. The Bedside Oral Exam and the Barrow
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Oral Care Protocol: translating evidence-based oral care into practice.
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10 Intensive Crit Care Nurs. 2013;29(5):282-290.
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12 doi:10.1016/j.iccn.2013.04.001
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15 7. Arruda FCF, Porto CC, Paula PRS, Prado M, Piccolo MS. Epidemiology of
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17 facial burns in patients hospitalized in a burn reference hospital. Rev Bras
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19 Queimaduras. 2021;20(1):9-13.
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