title: Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study.
abstract: BACKGROUND
  During critical illness, dental plaque may serve as a reservoir of respiratory pathogens. This study compared the effectiveness of toothbrushing with a small-headed toothbrush or a foam-headed swab in mechanically ventilated patients.
  
  
  METHODS
  This was a randomised, assessor-blinded, split-mouth trial, performed at a single critical care unit. Adult, orally intubated patients with >20 teeth, where >24 hours of mechanical ventilation was expected were included. Teeth were cleaned 12-hourly using a foam swab or toothbrush (each randomly assigned to one side of the mouth). Cleaning efficacy was based on plaque scores, gingival index and microbial plaque counts.
  
  
  RESULTS
  High initial plaque (mean=2.1 (SD 0.45)) and gingival (mean=2.0 (SD 0.54)) scores were recorded for 21 patients. A significant reduction compared with initial plaque index occurred using both toothbrushes (mean change=-1.26, 95% CI -1.57 to -0.95; p<0.001) and foam swabs (mean change=-1.28, 95% CI -1.54 to -1.01; p<0.001). There was significant reduction in gingival index over time using toothbrushes (mean change=-0.92; 95% CI -1.19 to -0.64; p<0.001) and foam swabs (mean change=-0.85; 95% CI -1.10 to -0.61; p<0.001). Differences between cleaning methods were not statistically significant (p=0.12 for change in gingival index; p=0.24 for change in plaque index). There was no significant change in bacterial dental plaque counts between toothbrushing (mean change 3.7×104colony-forming units (CFUs); minimum to maximum (-2.5×1010CFUs, 8.7×107CFUs)) and foam swabs (mean change 9×104CFUs; minimum to maximum (-3.1×1010CFUs, 3.0×107CFUs)).
  
  
  CONCLUSIONS
  Patients admitted to adult intensive care had poor oral health, which improved after brushing with a toothbrush or foam swab. Both interventions were equally effective at removing plaque and reducing gingival inflammation.
  
  
  BACKGROUND
  NCT01154257; Pre-results.
authors.affiliation: School of Dentistry, Cardiff University , Cardiff , UK.
authors.forename: Paola J
authors.initials: PJ
authors.lastname: Marino
authors.affiliation: Graduate Entry Medical School, University of Limerick , Limerick , Ireland.
authors.forename: Ailish
authors.initials: A
authors.lastname: Hannigan
authors.affiliation: School of Dentistry, Cardiff University , Cardiff , UK.
authors.forename: Sean
authors.initials: S
authors.lastname: Haywood
authors.affiliation: Adult Critical Care , University Hospital of Wales , Cardiff , UK.
authors.forename: Jade M
authors.initials: JM
authors.lastname: Cole
authors.affiliation: Adult Critical Care , University Hospital of Wales , Cardiff , UK.
authors.forename: Nicki
authors.initials: N
authors.lastname: Palmer
authors.affiliation: School of Dentistry, Cardiff University , Cardiff , UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Emanuel
authors.affiliation: School of Dentistry, Cardiff University , Cardiff , UK.
authors.forename: Tracey
authors.initials: T
authors.lastname: Kinsella
authors.affiliation: School of Dentistry, Cardiff University , Cardiff , UK.
authors.forename: Michael A O
authors.initials: MA
authors.lastname: Lewis
authors.affiliation: Adult Critical Care , University Hospital of Wales , Cardiff , UK.
authors.forename: Matt P
authors.initials: MP
authors.lastname: Wise
authors.affiliation: School of Dentistry, Cardiff University , Cardiff , UK.
authors.forename: David W
authors.identifier: 0000-0002-7351-5131
authors.initials: DW
authors.lastname: Williams
keywords: Assisted Ventilation; Bacterial Infection; Pneumonia; Respiratory Infection