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. 2025 Jul 29;29(8):392.
doi: 10.1007/s00784-025-06465-4.

Factors associated with oral candidosis and hyposalivation in intensive care unit patients: a prospective cohort study

Sarah Emily Melo da Silva  1 , Romana Rênery Fernandes  1 , Maria Eduarda Marques da Silva  1 , Héverton Oliveira Duarte  2 , Rosângela Oliveira da Câmara  2 , Maria Luiza Diniz de Sousa Lopes  1 , Ana Rafaela Luz de Aquino Martins  1 , Éricka Janine Dantas Da Silveira  3
Affiliations

Factors associated with oral candidosis and hyposalivation in intensive care unit patients: a prospective cohort study

Sarah Emily Melo da Silva et al. Clin Oral Investig. .

Abstract

Objective: To separately investigate the occurrence of oral candidosis and hyposalivation in Intensive Care Unit (ICU) patients and identify contributing factors.

Methods: A prospective cohort study was conducted with 100 ICU patients in a hospital in northeastern Brazil. Detailed intraoral examinations were performed daily by calibrated dentists, and sociodemographic and general health-related data were extracted from medical records. Pearson's Chi-square or Fisher's exact test assessed variable associations. Survival analysis estimated the onset time of oral candidosis and hyposalivation and their associations with risk factors.

Results: Among the 100 patients, 65% developed hyposalivation, and 11% presented oral candidiasis. The median age was 64 years, with a predominance of males. No significant associations were found between oral candidiasis and demographic or clinical variables. Hyposalivation was significantly linked to underlying renal disease, anemia, and the use of medications such as antibiotics, corticosteroids, anticholinergics, and bronchodilators. Co-occurrence of candidosis and hyposalivation were observed in 7 patients. There was no statistically significant association of the development of oral candidosis or hyposalivation with other oral changes. Anticoagulant use was significantly associated with a higher oral candidiasis-free survival rate. Underlying renal disease, antibiotic treatment, and orotracheal intubation were significantly associated with a reduced survival rate free from hyposalivation.

Conclusions: Hyposalivation was highly prevalent and may be linked to the development of other oral conditions, such as oral candidosis. Understanding factors that contribute to hyposalivation and oral candidosis is essential for improving ICU healthcare and enhancing patient recovery.

Clinical relevance: Early identification and management of hyposalivation should be prioritized in ICU protocols to enhance patient recovery and oral health care.

Keywords: Candidosis; Cohort study; Hyposalivation; Intensive care unit; Oral; Oral health.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Conflict of interest: The authors declare no competing interests. Ethics approval: This research was submitted to the Research Ethics Committee and received approval by Research Ethics Committee (CEP) of the Federal University of Rio Grande do Norte (UFRN) under protocol No. 5,499,485. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained from all participants or their legal representatives before inclusion in the study. For patients who were conscious and not sedated at the time of enrollment, the research team provided detailed information about the study objectives, procedures, potential risks, and benefits, and consent was signed by the patient. In cases where patients were sedated or otherwise unable to provide consent, authorization was obtained from a legally authorized representative (usually a family member) during regular ICU visitation hours. These procedures were in full accordance with ethical guidelines for research involving vulnerable populations.

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