Tooth brushing in critically ill patients has been advocated by many as a standard of care despite the limited evidence to support this practice. Attention has been focused on oral care as the evidence accumulates to support an association between the bacteria in the oral microbiome and those respiratory pathogens that cause pneumonia. It is plausible to assume that respiratory pathogens originating in the oral cavity are aspirated into the lungs, causing infection. A recent study of the effects of a powered toothbrush on the incidence of ventilator-associated pneumonia was stopped early because of a lack of effect in the treatment group. This review summarizes the evidence that supports the effectiveness of tooth brushing in critically ill adults and children receiving mechanical ventilation. Possible reasons for the lack of benefit of tooth brushing demonstrated in clinical trials are discussed. Recommendations for future trials in critically ill patients are suggested. With increased emphasis being placed on oral care, the evidence that supports this intervention must be evaluated carefully.
Pulmonary Critical Care| May 01 2011
Evidence to Support Tooth Brushing in Critically Ill Patients
Nancy J. Ames, RN, PhD, CCRN
Nancy J. Ames is a clinical nurse specialist at the Clinical Center at the National Institutes of Health in Bethesda, Maryland
Corresponding author: Nancy J. Ames, Nursing and Patient Care Services, Clinical Center, National Institutes of Health, Bldg 10, Rm 3-5627, 10 Center Dr, Bethesda, MD 20892 (e-mail: firstname.lastname@example.org).
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Am J Crit Care (2011) 20 (3): 242–250.
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Nancy J. Ames; Evidence to Support Tooth Brushing in Critically Ill Patients. Am J Crit Care 1 May 2011; 20 (3): 242–250. doi: https://doi.org/10.4037/ajcc2011120
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