Anti-Inflammatory and Anti-Bacterial Effects of Mouthwashes in Intensive Care Units: A Systematic Review and Meta-Analysis

Abstract

Mouthwashes are used as oral care for critical care patients to prevent infections. However, there are conflicting data concerning whether mouthwashes are needed as a part of daily oral care for critical care patients. This study aimed to evaluate the anti-inflammatory and anti-bacterial effects of mouthwashes for critical care patients. The PubMed, EMBASE, CENTRAL, and grey literature databases were searched by descriptors combining population (intensive care unit patients) and intervention (mouthwashes). After the screening, only randomized controlled trials (RCTs) evaluating the anti-inflammatory and anti-bacterial effects of mouthwashes in patient critical care were included. From the 1531 articles, 16 RCTs satisfied the eligibility criteria for systematic review and 10 were included in the meta-analyses. A significant difference was found in the incidence of ventilator associated pneumonia (VAP) (odds ratio [OR] 0.53, 95% confidential interval [95% CI] 0.33 to 0.86) between the mouthwash and placebo groups, while no significant difference was found in the mortality (OR 1.49, 95%CI 0.92 to 2.40); the duration of mechanical ventilation (weighted mean difference [WMD] −0.10, 95%CI −2.01 to 1.81); and the colonization of Staphylococcus aureus (OR 0.88, 95%CI 0.34 to 2.30), Escherichia coli (OR 1.19, 95%CI 0.50 to 2.82), and Pseudomonas aeruginosa (OR 1.16, 95%CI 0.27 to 4.91) between the two groups. In conclusion, mouthwashes were effective in decreasing the incidence of VAP. Thus, mouthwashes can be used as part of daily oral care for critical care patients.

Comparative Anti-inflammatory Activity of a Nanocomposite-Based Herbal Oral Rinse and a Commercial Oral Rinse

“…The NC formulation acts as a protective barrier, shielding bioactive compounds from premature degradation. By preventing degradation, the NC matrix maintains the stability and integrity of the phytochemicals, preserving their bioactivity and enhancing their overall bioavailability within the oral cavity [ 20 , 21 ]. The NC formulation enables targeted delivery of bioactive compounds to specific sites of inflammation in the oral cavity.…”

Protocolos de higiene bucal adotados em Unidades de Terapia Intensiva (UTI)

“…Alguns estudos mostraram um aumento do risco de morte com seu uso, mas ainda não está claro a associação da clorexidina nesse aumento, o que tem motivado a solicitações de mais estudos para investigar sua segurança em ambientes de cuidados intensivos (Wittekamp, et al, 2021). Baldino, et al, (2022) Embora haja discordância sobre a necessidade de enxaguantes bucais na rotina de higiene bucal de pacientes em tratamento, de acordo com Xiang, et al, 2022, pesquisas recentes sugeriram que esses produtos podem desempenhar um papel importante na redução da incidência de PAV em UTIs. Esses estudos destacaram que os compostos ativos encontrados nos enxaguantes bucais podem ser eficazes contra as bactérias associadas à PAV e que demonstram efeitos benéficos no controle da placa em concentrações entre 0,12% e 0,2% (Jun, et al, 2021).…”

Comparison of the effect of licorice and chlorhexidine mouthwash on the oral health of intubated patients in the intensive care unit

“…The best method of maintaining oral and dental hygiene in ICUs is still a matter of debate. Many previous studies have shown that using antibacterial mouthwashes such as chlorhexidine can help reduce dental plaque, gingivitis and ventilator-associated pneumonia [8][9][10], but these mouthwashes may also have side effects such as tooth discoloration, unpleasant taste, dry mouth and negative systemic effects [11,12]. On the other hand, some medicinal plants, such as liquorice, have antibacterial, anti-in ammatory, antiulcer and immunostimulatory properties that can be bene cial for the oral health of patients [13][14][15].…”