Oral health is integrally linked to overall well being. This paper describes a research program focused on the contribution of oral health to systemic illness. Initial investigations examined streptococcal virulence factors important in dental caries and endocarditis, and led to development of immunization strategies in animal models to reduce risk of endocarditis. Clinical investigations related to critically ill adults began with descriptive and observational studies that established the importance of dental plaque in development of ventilator-associated pneumonia (VAP) and examined existing nursing practices in oral care. Subsequent National Institutes of Health (NIH)-sponsored intervention studies to test oral-care protocols in critically ill adults have built upon that foundation.

Our first NIH-funded randomized clinical trial tested the effects of tooth brushing and chlorhexidine in reducing risk of VAP in critically ill adults, and showed that VAP was reduced by topical application of chlorhexidine initiated after...

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