Dental plaque colonization may be exacerbated in the absence of adequate oral hygiene care in critically ill, mechanically ventilated patients. Dental care is made more difficult due to the presence of the endotracheal tube, which may create:

• mechanical injury of the mouth or respiratory tract
• increased likelihood of dry mouth[1]

Using visual research and interviews, oral access and delivery of care for mechanically ventilated patients was analyzed, resulting in the following recommendations.

Recommendations to improve oral access and care delivery.

Dale CM, Angus JE, Sutherland S, Dev S, Rose L. Exploration of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care: A video and photographic elicitation study. J Clin Nurs. 2020 Jun;29(11-12):1920-1932. doi: 10.1111/jocn.15014. Epub 2019 Aug 20. PMID: 31342565.
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Additional Reading

1. Zhao T, Wu X, Zhang Q, Li C, Worthington HV, Hua F. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2020 Dec 24;12:CD008367. doi: 10.1002/14651858.CD008367.pub4. PMID: 33368159.
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2. Tanguay A, LeMay S, Reeves I, Gosselin É, St-Cyr-Tribble D. Factors influencing oral care in intubated intensive care patients. Nurs Crit Care. 2020 Jan;25(1):53-60. doi: 10.1111/nicc.12456. Epub 2019 Jul 15. PMID: 31305004.
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3. Warren C, Medei MK, Wood B, Schutte D. A Nurse-Driven Oral Care Protocol to Reduce Hospital-Acquired Pneumonia. Am J Nurs. 2019 Feb;119(2):44-51. doi: 10.1097/01.NAJ.0000553204.21342.01. PMID: 30681478.
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4. de Lacerda Vidal CF, Vidal AK, Monteiro JG Jr, Cavalcanti A, Henriques APC, Oliveira M, Godoy M, Coutinho M, Sobral PD, Vilela CÂ, Gomes B, Leandro MA, Montarroyos U, Ximenes RA, Lacerda HR. Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study. BMC Infect Dis. 2017 Jan 31;17(1):112. doi: 10.1186/s12879-017-2188-0. Erratum in: BMC Infect Dis. 2017 Feb 27;17 (1):173. PMID: 28143414; PMCID: PMC5286780.
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5. Collins T, Plowright C, Gibson V, Stayt L, Clarke S, Caisley J, Watkins CH, Hodges E, Leaver G, Leyland S, McCready P, Millin S, Platten J, Scallon M, Tipene P, Wilcox G. British Association of Critical Care Nurses: Evidence-based consensus paper for oral care within adult critical care units. Nurs Crit Care. 2020 Oct 29. doi: 10.1111/nicc.12570. Epub ahead of print. PMID: 33124119.
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