Apresentar revisão sistemática da literatura sobre o controle do biofilme bucal e a incidência da pneumonia nosocomial, avaliando e classificando os estudos quanto ao grau de recomendação e ao nível de evidência científica. A revisão foi realizada nas bases PubMed, LILACS e Scopus, de 1o de janeiro de 2000 até 31 de dezembro de 2012. Foram selecionados os estudos que avaliaram os cuidados com higiene bucal relacionando-os com infecções nosocomiais em paciente internados em unidades de terapia intensiva, seguindo os critérios de inclusão. Foram incluídos artigos na íntegra publicados em inglês, espanhol ou português, que abordavam alguma técnica de higiene bucal, química ou mecânica, na prevenção de pneumonia, as intervenções executadas e os resultados. Após análise dos dados, os artigos foram classificados quanto ao nível de evidência e o grau de recomendação, de acordo com os critérios daOxford Centre for Evidence-Based Medicine. Foram encontrados 297 resumos e, destes, 14 artigos na íntegra contemplaram nossos critérios. A maioria dos artigos incluía um grupo de estudo com uso de clorexidina e um controle com o uso de placebo para higiene bucal na prevenção de pneumonia. Quanto ao nível de evidência, todos os artigos foram classificados como B; quanto ao grau de recomendação, 12 artigos foram classificados como 2B e 2 como 2C. O controle do biofilme bucal reduz a incidência de pneumonia nosocomial, porém o nível de evidência e o grau de recomendação intermediário deixam evidente a necessidade da elaboração de estudos clínicos randomizados controlados com viés mínimo para estabelecer futuros protocolos para higiene bucal em unidades de terapia intensiva.

To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.

The incidence of oral manifestations of HIV infection is changing markedly. Oral afflictions previously uncommon in HIV condition are now emerging in this scenario and may be underestimated. Clinical characteristics of some oral diseases could change in the presence of HIV/AIDS infection and health care professionals must be made aware of such changes. Oral lesions of secondary syphilis are rare, however they can occur and the dentist should be able to diagnose them. In some cases the anamnesis and the clinical features of the lesions are not enough to diagnose this disease. Histological features and an acute knowledge on laboratory exams, as well as its applicability and limitations are necessary to diagnose it. The present report describes a case of secondary syphilis in an HIV positive patient. The patient showed red spots in the torso's skin and abdomen. The spots were also present on the hands but the color was darker. The oral mucosa had several ulcers, with variable shapes, sometimes recovered by a white and resistant membrane. They were present in the buccal mucosa, palate, gingiva, tongue and labial mucosa. Those clinical manifestations appeared 6 months earlier. Exams were performed (VDRL, FTA-abs, direct fungal exams in the skin and oral mucosa and a biopsy in the oral mucosa) but the diagnose remained unclear. Clinical and laboratory features disagreed and postponed the final diagnosis and the treatment for more than 6 months.

La incidencia de afecciones orales, antes infrecuentes en pacientes infectados por VIH, se está incrementando y es posible que se subestime. Las lesiones orales resultantes de la sífilis secundaria son raras; sin embargo, ocurren, y el odontólogo debería ser capaz de realizar un correcto diagnóstico. En algunos casos la anámnesis y los signos clínicos de las lesiones son insuficientes para permitir el diagnóstico de la enfermedad. El conocimiento de sus características histológicas y las pruebas de laboratorio relevantes, así como su aplicabilidad y limitaciones son necesarios para el correcto diagnóstico de la sífilis secundaria.