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Critical care
Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study
  1. Paola J Marino1,
  2. Ailish Hannigan2,
  3. Sean Haywood1,
  4. Jade M Cole3,
  5. Nicki Palmer3,
  6. Charlotte Emanuel1,
  7. Tracey Kinsella1,
  8. Michael A O Lewis1,
  9. Matt P Wise3 and
  10. David W Williams1
  1. 1School of Dentistry, Cardiff University, Cardiff, UK
  2. 2Graduate Entry Medical School, University of Limerick, Limerick, Ireland
  3. 3Adult Critical Care, University Hospital of Wales, Cardiff, UK
  1. Correspondence to Professor David W Williams; williamsdd{at}cardiff.ac.uk

Abstract

Introduction 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 3.7×104 colony-forming units (CFUs); minimum to maximum (−2.5×1010 CFUs, 8.7×107 CFUs)) and foam swabs (mean change 9×104 CFUs; minimum to maximum (−3.1×1010 CFUs, 3.0×107 CFUs)).

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.

Trial registration number NCT01154257; Pre-results.

  • Assisted Ventilation
  • Bacterial Infection
  • Pneumonia
  • Respiratory Infection

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjresp-2016-000150

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    Footnotes

    • MPW and DWW are joint last authors.

    • Contributors PJM, AH, SH, JMC, NP, CE, TK, MAOL, MPW, DWW provided substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. PJM, AH, MPW, DWW were involved in drafting the work or revising it critically for important intellectual content. MPW, DWW were involved in final approval of the version published. MPW, DWW provided agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding MPW was funded by a NISCHR AHSC Clinical Research Fellowship. MPW consulted for Bard, Merck (MSD), KaloBios Pharmaceuticals (Advisory Boards); has previously been employed by NISCHR AHSC (research fellowship 0.4 WTE); has received royalties from Wiley Publishing (book chapters); has received a fee for lecturing at an educational meeting from Fisher & Paykel, Merck (MSD); has received support for travel from ISICEM, Eli Lilly, British Thoracic Society, and Intensive Care Society; has received a loan of EIT equipment for research from CareFusion.

    • Competing interests This research was funded by Cardiff University and PJM was supported by a Walport Clinical Fellowship and obtained a research grant for consumables from a GSK-Oral and Dental Research Trust award. SAGE products gifted the toothbrushes and foam brushes used in this study.

    • Ethics approval Research Ethics Committee for Wales.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.