Toothbrushing to reduce ventilator-associated pneumonia pathogens and dental plaque in a critical care unit

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Ventilator-associated pneumonia (VAP) is a life-threatening condition in critically ill patients receiving mechanical ventilation. The incidence of VAP in varies between 9% and 45%  with mortality rates of up to 50% . It is accompanied by an increase both in length of stay in intensive care units ICU and healthcare.

The aim of this trial was to investigate the effect of a powered toothbrush on colonization of dental plaque by ventilator-associated pneumonia (VAP)-associated organisms and dental plaque removal.

The study  was a  parallel-arm, single-centre, examiner- and analyst-masked randomized controlled trial. Patients were recruited within 48-hrs of admission. The test group had oral hygiene performed by a nurse with a powered toothbrush with the  control group using a sponge toothette. This was conducted 4-times per day for 2-minutes  with groups receiving 20 ml, 0.2% chlorhexidine mouthwash at each time point.

They found:-

  • A low prevalence of respiratory pathogens throughout with no statistically significant differences between groups
  • A highly statistically significantly  reduction in dental plaque was produced by the powered toothbrush compared with the control treatment

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They concluded:-

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.

Needleman IG, Hirsch NP, Leemans M, Moles DR, Wilson M, Ready DR, Ismail S,Ciric L, Shaw MJ, Smith M, Garner A, Wilson S. Randomized controlled trial of toothbrushing to reduce ventilator-associated pneumonia pathogens and dental plaque in a critical care unit. J Clin Periodontol. 2011 Mar;38(3):246-52. doi:10.1111/j.1600-051X.2010.01688.x. Epub 2011 Jan 11. PubMed PMID: 21223352.

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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