Randomized controlled trial of toothbrushing to reduce ventilator-associated pneumonia pathogens and dental plaque in a critical care unit

Needleman, Ian; Hirsch, Nicholas; Leemans, Michele; Moles, David R; Wilson, Michael; Ready, Derren; Ismail, Salim; Ciric, Lena; Shaw, Michael; Smith, Martin; Garner, Anne; Wilson, Sally

doi:10.1111/j.1600-051x.2010.01688.x

Cited by 48 publications

(42 citation statements)

References 22 publications

(28 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For example, there could be cases where plaque indices differ not as a result of changes in bacterial number, but due to the relative quantity of EPS. This result is in contrast to the study of Needleman et al 43 where chlorhexidine in combination with a toothbrush or foam swab led to significant reductions in the number of plaque bacteria recovered.…”

Section: Discussioncontrasting

confidence: 99%

“…Needleman et al compared a powered toothbrush with a foam swab in 46 individually randomised patients, with cleaning undertaken four times a day for 2 min in combination with 20 mL of 0.2% chlorhexidine. The study found that a powered toothbrush was significantly better at reducing plaque 43. However, it was also observed that foam swabs reduced plaque scores significantly from baseline.…”

Section: Discussionmentioning

confidence: 89%

“…A similar dynamic was expected with gingival inflammation scores, although the initial response could take longer, to allow tissues to respond to the new conditions. Only one other study has compared use of a toothbrush with foam swabs during critical illness and measured plaque scores 43. Needleman et al compared a powered toothbrush with a foam swab in 46 individually randomised patients, with cleaning undertaken four times a day for 2 min in combination with 20 mL of 0.2% chlorhexidine.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study

et al. 2016

View full text Add to dashboard Cite

IntroductionDuring critical illness, dental plaque may serve as a reservoir of respiratory pathogens. This study compared the effectiveness of toothbrushing with a small-headed toothbrush or a foam-headed swab in mechanically ventilated patients.MethodsThis was a randomised, assessor-blinded, split-mouth trial, performed at a single critical care unit. Adult, orally intubated patients with >20 teeth, where >24 hours of mechanical ventilation was expected were included. Teeth were cleaned 12-hourly using a foam swab or toothbrush (each randomly assigned to one side of the mouth). Cleaning efficacy was based on plaque scores, gingival index and microbial plaque counts.ResultsHigh initial plaque (mean=2.1 (SD 0.45)) and gingival (mean=2.0 (SD 0.54)) scores were recorded for 21 patients. A significant reduction compared with initial plaque index occurred using both toothbrushes (mean change=−1.26, 95% CI −1.57 to −0.95; p<0.001) and foam swabs (mean change=−1.28, 95% CI −1.54 to −1.01; p<0.001). There was significant reduction in gingival index over time using toothbrushes (mean change=−0.92; 95% CI −1.19 to −0.64; p<0.001) and foam swabs (mean change=−0.85; 95% CI −1.10 to −0.61; p<0.001). Differences between cleaning methods were not statistically significant (p=0.12 for change in gingival index; p=0.24 for change in plaque index). There was no significant change in bacterial dental plaque counts between toothbrushing (mean change 3.7×104 colony-forming units (CFUs); minimum to maximum (−2.5×1010 CFUs, 8.7×107 CFUs)) and foam swabs (mean change 9×104 CFUs; minimum to maximum (−3.1×1010 CFUs, 3.0×107 CFUs)).ConclusionsPatients admitted to adult intensive care had poor oral health, which improved after brushing with a toothbrush or foam swab. Both interventions were equally effective at removing plaque and reducing gingival inflammation.Trial registration numberNCT01154257; Pre-results.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study

et al. 2016

View full text Add to dashboard Cite

show abstract

“…One report was translated from Spanish to English to evaluate eligibility (37). Of 14 potentially eligible studies, we excluded one Low risk of bias High study of toothbrushing which did not randomize patients (45); two studies that started as randomized trials but which became observationalstudies following low enrolment (46) or apparently large treatment effect (47), neither of which reported numerators or denominators; two trials that reported dental plaque but not VAP and that focused on the outcome of intracranial pressure (48,49); and three trials using toothbrushing as part of a standard oral care protocol in both groups testing chlorhexidine vs. control (50,51) or chlorhexidine vs. bicarbonate vs. control (52). Agreement on trial selection was 100%.…”

Section: Trial Identificationmentioning

confidence: 99%

Toothbrushing for Critically Ill Mechanically Ventilated Patients

Alhazzani

Smith

Muscedere

et al. 2013

Critical Care Medicine

View full text Add to dashboard Cite

In intubated, mechanically ventilated critically ill patients, toothbrushing did not significantly reduce the risk of ventilator-associated pneumonia overall. Toothbrushing has no effect on mortality or length of stay. Electric and manual toothbrushing seem to have similar effects. More research is needed on this aspect of oral care to evaluate its potential to decrease ventilator-associated pneumonia.

show abstract

“…Also, correct oral hygiene with tooth-brushing and oral decontamination with antiseptics (chlorhexidine and triclosan rinses on plaque, gingivitis, supragingival calculus and extrinsic staining) [14] has proven to be effective in reducing the incidence of ventilatorassociated pneumonia [15][16][17][18]. However, the role of poor oral hygiene and oropharyngeal bacterial colonization by potential respiratory pathogens on the development of community-acquired pneumonia (CAP) remains to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

Poor Oral Health as Risk Factor for Community-Acquired Pneumonia

Rodríguez¹,

Bolíbar²,

Serra‐Prat³

et al. 2014

J Pulm Respir Med

View full text Add to dashboard Cite

Objectives: Considerable evidence exists of the relationship between poor oral hygiene (therefore greater presence of plaque) and risk of pneumonia in special-care populations, including intensive care unit and nursing home settings. However, the effect of poor oral health on the development of community-acquired pneumonia (CAP) remains to be established. We assessed the relationship between CAP and oral health in general adult population. Study design:Over 1-year period, 1,336 incident cases of CAP and 1,326 controls were enrolled in a populationbased case-control study. A questionnaire on CAP risk factors that included oral health-related questions, including visit to dentist in the last month, bleeding gums, gingivitis, dental dysaesthesia, dental prosthesis, gumboil in the last month, teeth move or lost, and periodontal disease was administered to all participants. Results:The prevalence of dental dysaesthesia and use of dental prosthesis was significantly higher among patients with CAP than in control subjects (23.3% vs. 19.7%, P = 0.043, and 45.6% vs. 40.8%, P = 0.016, respectively), whereas visit to the dentist in the last month was a preventive factor against the development of CAP (odds ratio 0.71, 95% confidence interval 0.55-0.92, P = 0.008). Results of bivariate analysis were confirmed in the adjusted multivariate logistic regression models. Conclusions:Poor oral health may contribute to a higher risk for CAP in adult patients. Oral hygiene practices are particularly important in subjects with dental dysaesthesia and dental prosthesis. Not only odontologists but also dental hygienists should be aware of the relationship between oral health and potentially severe lung infection.

show abstract

Randomized controlled trial of toothbrushing to reduce ventilator-associated pneumonia pathogens and dental plaque in a critical care unit

Abstract: Powered toothbrushes are highly effective for plaque removal in intubated patients in a critical unit and should be tested for their potential to reduce VAP incidence and health complications.

Cited by 48 publications

References 22 publications

Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study

Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study

Toothbrushing for Critically Ill Mechanically Ventilated Patients

Poor Oral Health as Risk Factor for Community-Acquired Pneumonia

Contact Info

Product

Resources

About