SynthesisCritical care (London, England)2012
Impact of oral care with versus without toothbrushing on the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials.
Synthesis in Critical care (London, England), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 3 syntheses or guidelines pooled it, 46 citations in OpenAlex.
- Association Between Daily Toothbrushing and Hospital-Acquired Pneumonia: A Systematic Review and Meta-Analysis.JAMA internal medicine · 2024Pooled it
- An umbrella review of systematic reviews of the evidence of a causal relationship between periodontal microbes and respiratory diseases: Position paper from the Canadian Dental Hygienists Association.Canadian journal of dental hygiene : CJDH = Journal canadien de l'hygiene dentaire : JCHD · 2020Pooled it
- Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia.The Cochrane database of systematic reviews · 2016Pooled it
- Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study.BMC infectious diseases · 2017Trial
- Oral Hygiene Interventions and Pneumonia Prevention in Critical Care: An Integrative Review of Evidence and Practice.International journal of dentistry · 2026Review
- Assessment of Nursing Staff's Knowledge, Attitude and Practice Regarding Oral Hygiene Care in Intensive Care Unit Patients: A Multicenter Cross-sectional Study.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2024Article
- Prevention of Pneumonia due to Ventilator in Critical Patients with U Shape Oral Hygiene Model: A Systematic Review.Romanian journal of anaesthesia and intensive care · 2023Article
- Oral health care for the critically ill: a narrative review.Critical care (London, England) · 2021Review
- Hospital Dentistry for Intensive Care Unit Patients: A Comprehensive Review.Journal of clinical medicine · 2021Review
- Article
- Impact of a VAP bundle in Belgian intensive care units.Annals of intensive care · 2018Article
- Evidence summary: the relationship between oral health and pulmonary disease.British dental journal · 2017Review
- Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study.BMJ open respiratory research · 2016Article
- Year in review 2012: Critical Care--respiratory infections.Critical care (London, England) · 2013Review
- Toothbrushing for preventing ventilator-associated pneumonia.Critical care (London, England) · 2013Article
- Oral care and pulmonary infection - the importance of plaque scoring.Critical care (London, England) · 2013Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionVentilator-associated pneumonia (VAP) remains a common hazardous complication in mechanically ventilated patients and is associated with increased morbidity and mortality. We undertook a systematic review and meta-analysis of randomized controlled trials to assess the effect of toothbrushing as a component of oral care on the prevention of VAP in adult critically ill patients.
methodsA systematic literature search of PubMed and Embase (up to April 2012) was conducted. Eligible studies were randomized controlled trials of mechanically ventilated adult patients receiving oral care with toothbrushing. Relative risks (RRs), weighted mean differences (WMDs), and 95% confidence intervals (CIs) were calculated and heterogeneity was assessed with the I(2) test.
resultsFour studies with a total of 828 patients met the inclusion criteria. Toothbrushing did not significantly reduce the incidence of VAP (RR, 0.77; 95% CI, 0.50 to 1.21) and intensive care unit mortality (RR, 0.88; 95% CI, 0.70 to 1.10). Toothbrushing was not associated with a statistically significant reduction in duration of mechanical ventilation (WMD, -0.88 days; 95% CI, -2.58 to 0.82), length of intensive care unit stay (WMD, -1.48 days; 95% CI, -3.40 to 0.45), antibiotic-free day (WMD, -0.52 days; 95% CI, -2.82 to 1.79), or mechanical ventilation-free day (WMD, -0.43 days; 95% CI, -1.23 to 0.36).
conclusionsOral care with toothbrushing versus without toothbrushing does not significantly reduce the incidence of VAP and alter other important clinical outcomes in mechanically ventilated patients. However, the results should be interpreted cautiously since relevant evidence is still limited, although accumulating. Further large-scale, well-designed randomized controlled trials are urgently needed.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.