title: Effectiveness of a dental care intervention in the prevention of lower respiratory tract nosocomial infections among intensive care patients: a randomized clinical trial.
abstract: OBJECTIVE
  To evaluate whether dental treatment may enhance oral antisepsis, thus preventing more effectively lower respiratory tract infections (LRTIs) among critically ill patients.
  
  
  METHODS
  Observer-blind randomized clinical trial.
  
  
  METHODS
  General intensive care unit (ICU) for adult patients.
  
  
  METHODS
  We analyzed data from 254 adult patients who stayed for at least 48 hours in the ICU.
  
  
  METHODS
  Patients were randomized by means of rolling dice. The experimental group (n = 127) had access to dental care provided by a dental surgeon, 4-5 times a week. Besides routine oral hygiene, care also included teeth brushing, tongue scraping, removal of calculus, atraumatic restorative treatment of caries, and tooth extraction. The control group (n = 127) had access to routine oral hygiene only, which included the use of chlorhexidine as a mouth rinse, which was performed by the ICU nurse staff.
  
  
  RESULTS
  The primary study outcome was the LRTI incidence, which was 8.7% in the experimental group and 18.1% in the control group (adjusted relative risk [RR], 0.44 [95% confidence interval (CI), 0.20-0.96]; P = .04). Ventilator-associated pneumonia rates per 1,000 ventilator-days were 16.5 (95% CI, 9.8-29.5) in the control group and 7.6 (95% CI, 3.3-15.0) in the experimental group (P < .05). Mortality rates were similar between both study groups: 31.5% in the control group versus 29.1% in the experimental group (adjusted RR, 0.93 [95% CI, 0.52-1.65]; P = .796). No severe adverse events related to oral care were observed during the study.
  
  
  CONCLUSIONS
  Dental treatment was safe and effective in the prevention of LRTI among critically ill patients who were expected to stay at least 48 hours in the ICU.
  
  
  BACKGROUND
  Brazilian Clinical Trials Registry, affiliated with the World Health Organization's International Clinical Trial Registry Platform: U1111-1152-2671.
authors.affiliation: Infectious Diseases Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Wanessa T
authors.initials: WT
authors.lastname: Bellissimo-Rodrigues
authors.forename: Mayra G
authors.initials: MG
authors.lastname: Menegueti
authors.forename: Gilberto G
authors.initials: GG
authors.lastname: Gaspar
authors.forename: Edson A
authors.initials: EA
authors.lastname: Nicolini
authors.forename: Maria
authors.initials: M
authors.lastname: Auxiliadora-Martins
authors.forename: Anibal
authors.initials: A
authors.lastname: Basile-Filho
authors.forename: Roberto
authors.initials: R
authors.lastname: Martinez
authors.forename: Fernando
authors.initials: F
authors.lastname: Bellissimo-Rodrigues
mesh_terms: D000328:Adult; D001938:Brazil; D002710:Chlorhexidine / Q000627:therapeutic use; D003422:Critical Care; D003729:Dental Care; D003793:Dental Restoration, Permanent; D012534:Dental Scaling; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology; D009067:Mouthwashes / Q000627:therapeutic use; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects*; D016037:Single-Blind Method; D014081:Tooth Extraction; D014099:Toothbrushing
chemical_list: D009067:Mouthwashes; D002710:Chlorhexidine