title: Oral care and nosocomial pneumonia: a systematic review.
abstract: To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.
authors.affiliation: Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Maria Carolina Nunes
authors.initials: MC
authors.lastname: Vilela
authors.affiliation: Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil.
authors.forename: Gustavo Zanna
authors.initials: GZ
authors.lastname: Ferreira
authors.affiliation: Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil.
authors.forename: Paulo Sérgio da Silva
authors.initials: PS
authors.lastname: Santos
authors.affiliation: Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Nathalie Pepe Medeiros de
authors.initials: NP
authors.lastname: Rezende
mesh_terms: D002710:Chlorhexidine / Q000627:therapeutic use; D003428:Cross Infection / Q000150:complications / Q000517:prevention & control*; D003773:Dental Plaque / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D004202:Disinfectants / Q000627:therapeutic use; D055317:Evidence-Based Practice / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D009910:Oral Hygiene / Q000379:methods*; D053717:Pneumonia, Ventilator-Associated / Q000150:complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000009:adverse effects; D014099:Toothbrushing / Q000009:adverse effects
chemical_list: D004202:Disinfectants; D002710:Chlorhexidine