No conclusion is possible on the best methods of delivering one-to-one oral hygiene advice

Dentist using props to show a patient how to brush her teethPoor oral hygiene habits are known to be associated with high rates of dental decay and gum disease. The dental team routinely assesses oral hygiene methods, frequency and effectiveness or otherwise of oral hygiene routines carried out by their patients. Oral hygiene routines can include toothbrushing, reducing sugar intake, interdental cleaning with floss or interdental brushes, and using a fluoride mouthwash or dentifrice. One-to-one oral hygiene advice is regularly provided by members of the dental team with the aim of motivating individuals and improving their oral health. The most effective method of delivering one-to-one advice in the dental setting is unclear. This review’s aim is to determine if providing patients with one-to-one oral hygiene advice in the dental setting is effective, and if so what is the best way to deliver this advice. Continue reading

Professional oral mouth care for nursing home residents: is it more effective than usual care?

Pneumonia is common among elderly people living in nursing homes. Nursing home‐acquired pneumonia (NHAP) is a bacterial infection of the lung that occurs in residents of long‐term care facilities and nursing homes. Poor oral hygiene is considered to contribute to the likelihood of contracting an infection. Professional mouth care is a combination of brushing teeth and mucosa, cleaning dentures, using mouthrinse, and check‐up visits to a dentist, while usual mouth care is generally less intensive, and is self‐administered, or provided by nursing home staff without special training in oral hygiene. Continue reading

What’s the evidence on the best approach to supportive periodontal therapy?

Periodontitis (gum disease) is a chronic condition caused by bacteria, which stimulate inflammation and destruction of the bone and gum tissue supporting teeth. People treated for periodontitis can reduce the probability of re-infection and disease progression through regular supportive periodontal therapy (SPT). SPT starts once periodontitis has been treated satisfactorily, meaning that inflammation has been controlled and destruction of tissues supporting the tooth (bone and gums) has been arrested. SPT aims to maintain teeth in function, without pain, excessive mobility or persistent infection over the long term. SPT treatment typically includes ensuring excellent oral hygiene, frequent monitoring for progression or recurrence of disease, and removal of microbial deposits by dental professionals. Although success of SPT has been suggested through a number of long-term, retrospective studies, it is important to consider evidence available from randomised controlled trials (RCTs). Continue reading

Chlorhexidine may reduce the risk of ventilator-associated pneumonia in patients treated in intensive care units

CCUCritically ill people, who may be unconscious or sedated while they are treated in ICUs, often need to have machines to help them breathe (ventilators). The use of these machines for more than 48 hours may result in ventilator-associated pneumonia (VAP). VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care, using a mouthrinse, gel, toothbrush, or combination, together with breathing-in of secretions, may reduce the risk of VAP in these patients. Continue reading

Education for nursing home staff and/or residents to improve residents’ oral health

kind care for senior womanNursing home residents are often unable to carry out proper oral care, which is an important factor in maintaining the health of the mouth, teeth, and gums. Nursing home staff may not be prepared to provide adequate care. Therefore, oral health care education for residents and/or nursing staff may be one strategy to improve this situation. Continue reading

New title registered at the Cochrane Oral Health Group

teeth

Photo by: babyparenting.about.com/

The Cochrane Oral Health Group registered one new title at their Editorial Meeting in April:

Interventions for preventing early childhood caries in pregnant women and mothers of infants up to 12 months old

This new review looks at early and maternal prevention of tooth decay in babies and is part of a larger project to improve oral health outcomes for children of migrant refugee communities.

 

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Review of the month: critically ill patients can benefit from improved oral health

vap

C Cambridge University Hospitals NHS Foundation Trust

Critically ill people who need machines to help them breathe are at high risk for developing chest infections and pneumonia. This is known as ventilator-associated pneumonia, or VAP. Can a programme of oral care (such as mouthwashes, toothbrushing) help to prevent this life-threatening condition?

What was the research?

A systematic review of the evidence to find out whether oral health care can reduce the likelihood of a patient in intensive care on a ventilator developing pneumonia.

Who conducted the research?

The research was conducted by a team led by Zongdao Shi on behalf of the Cochrane Oral Health Group. Huixu Xie, Ping Wang, Qi Zhang, Yan Wu, E Chen, Linda Ng, Helen V Worthington, Ian Needleman and Susan Furness were also on the team.

What evidence was included in the review?

Data was extracted from 35 randomised controlled trials. A total of 5,374 patients participated in the trials. The trials looked at:

  1. Chlorhexidine antiseptic mouthrinse or gel compared with a placebo or usual care.
  2. Toothbrushing compared with no toothbrushing
  3. Powered compared with manual toothbrushing
  4. Oral care with other solutions.

Participants were all critically ill and needed assistance from hospital staff, who administered the oral care.

What did the evidence say?

The review found that chlorhexidine administered as a mouthrinse or gel reduces the odds of VAP by 40%. For every 15 people in hospital in intensive care, use of oral hygiene including chlorhexidine will prevent one person developing VAP. There was no evidence that chlorhexidine makes a difference to the numbers of patients who die in intensive care, or the length of their stay in the intensive care unit. There was no evidence that toothbrushing or oral care without toothbrushing affected the risk of developing VAP. Two studies showed some evidence of a reduction in VAP with povidine iodine antiseptic mouthrinse. There was not enough evidence of the effects of other oral care solutions, such as water, saline or triclosan.

How good was the evidence?

Only 14% of the studies included in this review were well conducted and described. Almost half of the included studies were at high risk of bias.

What are the implications for intensive care staff and the general public?

Effective oral hygiene care is important for ventilated patients in intensive care to reduce ventilator-associated pneumonia. There is evidence from this review that oral hygiene care incorporating chlorhexidine mouthrinse or gel is effective in reducing the development of ventilator-associated pneumonia in adult patients in intensive care. The definition of oral hygiene care varied among the studies included in this review but common elements include cleaning of the teeth and gums with a swab or gauze, removing secretions using suction and rinsing the mouth.

What should researchers look at in the future?

Although the included studies provided some evidence of the benefits of oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia, incomplete reporting of studies is a major limitation. Further trials of oral hygiene care (including use of manual or powered toothbrushes, or swabs) should report both measures of effectiveness of plaque removal and prevention of ventilator-associated pneumonia.

Link

Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, Ng L, Worthington HV, Needleman I, Furness S. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD008367. DOI: 10.1002/14651858.CD008367.pub2.