title: Randomized controlled trial of toothbrushing to reduce ventilator-associated pneumonia pathogens and dental plaque in a critical care unit.
abstract: OBJECTIVE
  To investigate the effect of a powered toothbrush on colonization of dental plaque by ventilator-associated pneumonia (VAP)-associated organisms and dental plaque removal.
  
  
  METHODS
  Parallel-arm, single-centre, examiner- and analyst-masked randomized controlled trial. Forty-six adults were recruited within 48 h of admission. Test intervention: powered toothbrush, control intervention: sponge toothette, both used four times per day for 2 min. Groups received 20 ml, 0.2% chlorhexidine mouthwash at each time point.
  
  
  RESULTS
  The results showed a low prevalence of respiratory pathogens throughout with no statistically significant differences between groups. A highly statistically significantly greater reduction in dental plaque was produced by the powered toothbrush compared with the control treatment; mean plaque index at day 5, powered toothbrush 0.75 [95% confidence interval (CI) 0.53, 1.00], sponge toothette 1.35 (95% CI 0.95, 1.74), p=0.006. Total bacterial viable count was also highly statistically significantly lower in the test group at day 5; Log(10) mean total bacterial counts: powered toothbrush 5.12 (95% CI 4.60, 5.63), sponge toothette 6.61 (95% CI 5.93, 7.28), p=0.002.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Unit of Periodontology, International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, London, UK. i.needleman@eastman.ucl.ac.uk
authors.forename: Ian G
authors.initials: IG
authors.lastname: Needleman
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Hirsch
authors.forename: Michele
authors.initials: M
authors.lastname: Leemans
authors.forename: David R
authors.initials: DR
authors.lastname: Moles
authors.forename: Michael
authors.initials: M
authors.lastname: Wilson
authors.forename: Derren R
authors.initials: DR
authors.lastname: Ready
authors.forename: Salim
authors.initials: S
authors.lastname: Ismail
authors.forename: Lena
authors.initials: L
authors.lastname: Ciric
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Shaw
authors.forename: Martin
authors.initials: M
authors.lastname: Smith
authors.forename: Anne
authors.initials: A
authors.lastname: Garner
authors.forename: Sally
authors.initials: S
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D058491:Bacterial Load; D002710:Chlorhexidine / Q000627:therapeutic use; D003422:Critical Care; D003773:Dental Plaque / Q000382:microbiology* / Q000517:prevention & control; D003774:Dental Plaque Index; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000627:therapeutic use; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology*; D016037:Single-Blind Method; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014099:Toothbrushing / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000891:Anti-Infective Agents, Local; D009067:Mouthwashes; D002710:Chlorhexidine