title: Impact of tongue biofilm removal on mechanically ventilated patients.
abstract: OBJECTIVE
  To evaluate the effectiveness of a tongue cleaner in the removal of tongue biofilm in mechanically ventilated patients.
  
  
  METHODS
  Tongue biofilm and tracheal secretion samples were collected from a total of 50 patients: 27 in the study group (SG) who were intubated or tracheostomized under assisted ventilation and treated with the tongue cleaner and 23 in the control group (CG) who did not undergo tongue cleaning. Oral and tracheal secretion cultures of the SG (initially and after 5 days) and the CG (at a single time-point) were performed to evaluate the changes in bacterial flora.
  
  
  RESULTS
  The median age of the SG patients was 77 years (45-99 years), and that of the CG patients was 79 years (21-94 years). The length of hospital stay ranged from 17-1,370 days for the SG with a median stay of 425 days and from 4-240 days for the CG with a median stay of 120 days. No significant differences were found when the dental plaque indexes were compared between the SG and the CG. There was no correlation between the index and the length of hospital stay. The same bacterial flora was found in the dental plaque of 9 of the 27 SG patients before and after the tongue scraper was used for 5 days compared with the CG (p=0.683). Overall, 7 of the 27 SG patients had positive bacterial cultures for the same strains in both tongue biofilm and tracheal secretions compared with the CG (p=0.003). Significant similarities in strain resistance and susceptibility of the assessed microorganisms were observed between oral and tracheal microflora in 6/23 cases in the CG (p=0.006).
  
  
  CONCLUSIONS
  The use of a tongue cleaner is effective at reducing tongue biofilm in patients on mechanical ventilation and facilitates oral hygiene interventions performed by caregivers.
authors.affiliation: Department of Stomatology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Brazil. paulosss@fob.usp.br
authors.forename: Paulo Sérgio da Silva
authors.initials: PS
authors.lastname: Santos
authors.forename: Marcelo
authors.initials: M
authors.lastname: Mariano
authors.forename: Monira Samaan
authors.initials: MS
authors.lastname: Kallas
authors.forename: Maria Carolina Nunes
authors.initials: MC
authors.lastname: Vilela
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018441:Biofilms; D003773:Dental Plaque / Q000382:microbiology; D003774:Dental Plaque Index; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D014059:Tongue / Q000382:microbiology*; D014132:Trachea / Q000378:metabolism; D055815:Young Adult