title: Oral health and ventilator-associated pneumonia among critically ill patients: a prospective study.
abstract: OBJECTIVE
  To evaluate the association between oral health and ventilator-associated pneumonia (VAP) among critically ill patients.
  
  
  METHODS
  A prospective cohort study was conducted among 162 critically ill patients newly intubated and treated with mechanical ventilator in one tertiary hospital in Thailand. Oral health status was assessed using Oral Health Assessment Tool (OHAT), Plaque Index (PI), and number of teeth. VAP, defined as Clinical Pulmonary Infection Score >6, was assessed on Day 4 after intubation. Hazard ratios and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression adjusted for confounders.
  
  
  RESULTS
  Critically ill patients had deteriorating oral health status after intubation. Early-onset VAP developed in 69 patients (42.6%), with VAP incidence of 117 episodes per 1000 ventilator-days. Moderately unhealthy and unhealthy oral conditions based on OHAT scores were associated with a 2.92-fold (95% CI: 1.26-6.74) and 3.22-fold (95% CI: 1.34-7.76) increased risk of VAP. Patients with moderate-to-very poor oral hygiene assessed by PI had increased VAP risk of 1.66-folds (95% CI: 1.001-2.75). The number of teeth was not associated with VAP development.
  
  
  CONCLUSIONS
  There is a strong association between poor oral health and increased risk for early-onset VAP. Routine oral care possibly prevents VAP development among critically ill patients treated with mechanical ventilator.
authors.affiliation: Graduate School, Khon Kean University, Khon Kaen, Thailand.|Faculty of Nursing, Khon Kean University, Khon Kaen, Thailand.
authors.forename: D
authors.initials: D
authors.lastname: Saensom
authors.affiliation: School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: A T
authors.initials: AT
authors.lastname: Merchant
authors.affiliation: Faculty of Dentistry, Khon Kean University, Khon Kaen, Thailand.|Chronic Inflammatory and Systemic Diseases Associated with Oral Health Research Group, Khon Kean University, Khon Kaen, Thailand.
authors.forename: N
authors.initials: N
authors.lastname: Wara-Aswapati
authors.affiliation: Faculty of Nursing, Khon Kean University, Khon Kaen, Thailand.
authors.forename: W
authors.initials: W
authors.lastname: Ruaisungnoen
authors.affiliation: Faculty of Dentistry, Khon Kean University, Khon Kaen, Thailand. waranuch@kku.ac.th.|Chronic Inflammatory and Systemic Diseases Associated with Oral Health Research Group, Khon Kean University, Khon Kaen, Thailand. waranuch@kku.ac.th.
authors.forename: W
authors.initials: W
authors.lastname: Pitiphat
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D009909:Oral Health; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology*; D011446:Prospective Studies
keywords: critically ill patients; oral health; ventilator-associated pneumonia