Prone Position in Management of COVID-19 Patients and Dentistry

Prone Position in Management of COVID-19 Patients and Dentistry

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