Oral Health and Care in the Intensive Care Unit: State of the Science

Abstract

Oral health is influenced by oral microbial flora, which are concentrated in dental plaque. Dental plaque provides a microhabitat for organisms and an opportunity for adherence of the organisms to either the tooth surface or other microorganisms. In critically ill patients, potential pathogens can be cultured from the oral cavity. These microorganisms in the mouth can translocate and colonize the lung, resulting in ventilator-associated pneumonia. The importance of oral care in the intensive care unit has been noted in the literature, but little research is available on mechanical or pharmacological approaches to reducing oral microbial flora via oral care in critically ill adults. Most research in oral care has been directed toward patients’ comfort; the microbiological and physiological effects of tooth brushing in the intensive care unit have not been reported. Although 2 studies indicated reductions in rates of ventilator-associated pneumonia in cardiac surgery patients who received chlorhexidine before intubation and postoperatively, the effects of chlorhexidine in reducing ventilator-associated pneumonia in other populations of critically ill patients or its effect when treatment with the agent initiated after intubation have not been reported. In addition, no evaluation of the effectiveness of pharmacological and mechanical interventions relative to each other or in combination has been published. Additional studies are needed to develop and test best practices for oral care in critically ill patients.

Translating evidence into nursing practice: oral hygiene for care dependent adults

“…6 We highlighted that proper dilution is necessary to avoid superficial burns. 9,32 Denture care We suggested cleaning denture with water. When they were not in use, we recommended soaking them in clean water in a container, changing the water in container at least once a day, cleaning the container with soap and water, and disposing the container after using for a week.…”

“…32 This can predispose patients to complications such as aspiration pneumonia or bacteraemia. 32 Thus careful tooth brushing is advised, especially when it is done in immunocompromised critically ill patients. 8 Foam swabs were reported to be less effective than tooth brushing in removing plaques.…”

“…6 Care should be taken to ensure appropriate dilution to avoid superficial burns. 9,32 Patients receiving medications such as opiates and diuretics, oxygen therapy, or who were on reduced fluid intake can suffer from xerostomia (sensation of dryness in the mouth). 9 This can lead to difficulty in speaking.…”

The interface between oral and systemic health: the need for more collaboration

“…Effective oral hygiene keeps the mouth functional and comfortable and, more importantly, reduces the risk of local and systemic infection [20]. Nurses often lack training in the recognition of oral complications and the optimal techniques for oral care [21]. In fact, it is very difficult to maintain oral care when the patient has an endotracheal tube that, if displaced, can result in a life-threatening situation [20].…”

Oral health promotion in patients with chronic renal failure admitted in the Intensive Care Unit

“…This infection risk due to the fact that after three days in the hospital, especially in the ICU, there is increased bacterial colonization, particularly gram-negative ones, associated with VAP in the oral cavity and oropharynx. Such condition reinforces the need for effective oral health practices that are able to decrease this systemic framework rate [3][4][5][6].…”