(Dr. Joseph D. Lim Dr. Kenneth Lester Lim)
ORAL hygiene reduces the need for care in the Intensive Care Unit (ICU).
Oral care also decreases both the length of stay in the ICU as well as the amount of time of mechanical ventilation, a new study says.
Patients on mechanical ventilation who brushed their teeth and used chlorhexidine mouthwash had a reduced chance of developing ventilator-associated pneumonia (VAP), says the study published in Cureus, an open access medical journal for doctors, researchers and patients.
VAP is one of the most common infections among intubated patients in ICUs. Oral care with chlorhexidine is a conventional method for maintaining hygiene.
Recently, adjuvant methods have been introduced into routine oral care, including teeth brushing and the application of moisturizing lotion.
The objective of the study was to compare the incidence of VAP in critical care patients receiving oral care with and without manual teeth brushing and the application of moisturizers to the mouth.
The study was conducted by Drs. Pallika Singh, an anesthesiologist at the Autonomous State Medical College, Firozabad, India; of the Anesthesiology and Critical Care, King George’s Medical University, Lucknow, India; and Radhey S. Gangwar of the King George’s Medical University, Lucknow.
The study shows a lower mortality rate among patients who both brushed their teeth and used chlorhexidine mouth wash, says Dr. Singh the principal author.
The research was conducted using a prospective randomized control study including 220 patients who were on ventilation in the ICU between May 2019 and April 2020.
The study conducted a prospective randomized control study comprised of 220 ICU patients between 18 and 65 years of age, and of either sex.
The ratio of female and male patients was nearly even, with only two more male patients than female. The mean age was 39.06 (15.56) years.
The patients were divided into two groups of 110 each. Care for the study group consisted of chlorhexidine wash, tooth brushing, and moisturizing gel over gums, buccal mucosa, and lips.
The control group was treated with chlorhexidine wash only. The oral assessment was done at 4, 6, 8, and 12 hours using the Beck Oral Assessment Scale (BOAS). Pneumonia was assessed based on abnormal chest x-rays, fever; the incidence of VAP, and mortality was observed.
The study found that abnormal chest X-rays, positive culture reports, fevers, positive auscultatory findings, and incidence of VAP and mortality were all significantly reduced in the study group compared with the control group.
Fever was present in a significantly higher proportion of cases (75.5 percent) in the control group compared with the study group (42.7 percent). Oxygen saturation levels were also significantly higher in the study group compared with the control group.
A significantly greater proportion (47.3 percent) of patients in the study group had normal chest X-rays compared with the control group (23.6 percent).
The number of days in the ICU was significantly lower among those practicing additional oral hygiene. The study group patients stayed in the ICU around 12 days compared with control group patients who stayed around 15 days, on average.
Mechanical ventilation length was also significantly reduced, dropping from about 14 days in the control group to about 11 days in the study group, on average.
The study concluded that oral care with chlorhexidine mouth wash and the adjuvant measures reduced VAP and, consequently mortality and hospital stays.
Tooth brushing along with standard oral care provides an additional advantage in the prevention of VAP in mechanically ventilated patients.
Compulsory tooth brushing, if included in regular oral care, yields better results in terms of decreased incidence of VAP, length of ICU stay.
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Dr. Joseph D. Lim, Ed. D., is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; Honorary Life Member of the Thai Association of Dental Implantology; and Founding Chairman of the Philippine College of Oral Implantologists. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.
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Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines, College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De la Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate Professor; Fellow, International Congress of Oral Implantologists; Member, American Academy of Implant Dentistry and Fellow, Philippine College of Oral Implantologists. For questions on dental health, e-mail limdentalcenter@gmail.com./PN
