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Highly Accessed Open Badges Commentary

Oral care and pulmonary infection - the importance of plaque scoring

Matt P Wise1* and David W Williams2

Author Affiliations

1 Adult Critical Care, University Hospital of Wales, Cardiff, CF14 4XW, UK

2 School of Dentistry, Cardiff University, Cardiff, CF14 4XY, UK

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Critical Care 2012, 17:101  doi:10.1186/cc11896

See related research by Gu et al.,

Published: 10 January 2013


Improving the quality of oral hygiene is recognised as an important counter measure for reducing the incidence of ventilator-associated pneumonia amongst critically ill patients. Toothbrushing physically disrupts the dental plaque that acts as a reservoir for pulmonary infection and therefore has the potential to reduce the incidence of ventilator-associated pneumonia. Gu and colleagues performed a systematic review and meta-analysis of oral hygiene with and without a toothbrush and found no difference in the incidence of pneumonia in mechanically ventilated patients. The diagnosis of ventilator-associated pneumonia is prone to bias and future studies of oral care interventions should focus on measures of oral cleanliness such as plaque and gingival scores. Once the optimal strategy for oral hygiene is defined in the critically ill, larger studies focussing on ventilator-associated pneumonia or mortality can be conducted.