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The Cochrane Database of Systematic... Dec 2020Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, swab, toothbrush, or combination, together with suction of secretions, may reduce the risk of VAP in these patients.
OBJECTIVES
To assess the effects of oral hygiene care (OHC) on incidence of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation in hospital intensive care units (ICUs).
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 25 February 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2020, Issue 1), MEDLINE Ovid (1946 to 25 February 2020), Embase Ovid (1980 to 25 February 2020), LILACS BIREME Virtual Health Library (1982 to 25 February 2020) and CINAHL EBSCO (1937 to 25 February 2020). We also searched the VIP Database (January 2012 to 8 March 2020). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) evaluating the effects of OHC (mouthrinse, gel, swab, toothbrush or combination) in critically ill patients receiving mechanical ventilation for at least 48 hours.
DATA COLLECTION AND ANALYSIS
At least two review authors independently assessed search results, extracted data and assessed risk of bias in included studies. We contacted study authors for additional information. We reported risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, using the random-effects model of meta-analysis when data from four or more trials were combined.
MAIN RESULTS
We included 40 RCTs (5675 participants), which were conducted in various countries including China, USA, Brazil and Iran. We categorised these RCTs into five main comparisons: chlorhexidine (CHX) mouthrinse or gel versus placebo/usual care; CHX mouthrinse versus other oral care agents; toothbrushing (± antiseptics) versus no toothbrushing (± antiseptics); powered versus manual toothbrushing; and comparisons of other oral care agents used in OHC (other oral care agents versus placebo/usual care, or head-to-head comparisons between other oral care agents). We assessed the overall risk of bias as high in 31 trials and low in two, with the rest being unclear. Moderate-certainty evidence from 13 RCTs (1206 participants, 92% adults) shows that CHX mouthrinse or gel, as part of OHC, probably reduces the incidence of VAP compared to placebo or usual care from 26% to about 18% (RR 0.67, 95% confidence intervals (CI) 0.47 to 0.97; P = 0.03; I = 66%). This is equivalent to a number needed to treat for an additional beneficial outcome (NNTB) of 12 (95% CI 7 to 128), i.e. providing OHC including CHX for 12 ventilated patients in intensive care would prevent one patient developing VAP. There was no evidence of a difference between interventions for the outcomes of mortality (RR 1.03, 95% CI 0.80 to 1.33; P = 0.86, I = 0%; 9 RCTs, 944 participants; moderate-certainty evidence), duration of mechanical ventilation (MD -1.10 days, 95% CI -3.20 to 1.00 days; P = 0.30, I = 74%; 4 RCTs, 594 participants; very low-certainty evidence) or duration of intensive care unit (ICU) stay (MD -0.89 days, 95% CI -3.59 to 1.82 days; P = 0.52, I = 69%; 5 RCTs, 627 participants; low-certainty evidence). Most studies did not mention adverse effects. One study reported adverse effects, which were mild, with similar frequency in CHX and control groups and one study reported there were no adverse effects. Toothbrushing (± antiseptics) may reduce the incidence of VAP (RR 0.61, 95% CI 0.41 to 0.91; P = 0.01, I = 40%; 5 RCTs, 910 participants; low-certainty evidence) compared to OHC without toothbrushing (± antiseptics). There is also some evidence that toothbrushing may reduce the duration of ICU stay (MD -1.89 days, 95% CI -3.52 to -0.27 days; P = 0.02, I = 0%; 3 RCTs, 749 participants), but this is very low certainty. Low-certainty evidence did not show a reduction in mortality (RR 0.84, 95% CI 0.67 to 1.05; P = 0.12, I = 0%; 5 RCTs, 910 participants) or duration of mechanical ventilation (MD -0.43, 95% CI -1.17 to 0.30; P = 0.25, I = 46%; 4 RCTs, 810 participants).
AUTHORS' CONCLUSIONS
Chlorhexidine mouthwash or gel, as part of OHC, probably reduces the incidence of developing ventilator-associated pneumonia (VAP) in critically ill patients from 26% to about 18%, when compared to placebo or usual care. We did not find a difference in mortality, duration of mechanical ventilation or duration of stay in the intensive care unit, although the evidence was low certainty. OHC including both antiseptics and toothbrushing may be more effective than OHC with antiseptics alone to reduce the incidence of VAP and the length of ICU stay, but, again, the evidence is low certainty. There is insufficient evidence to determine whether any of the interventions evaluated in the studies are associated with adverse effects.
Topics: Adult; Child; Chlorhexidine; Critical Illness; Humans; Incidence; Intensive Care Units; Length of Stay; Mouthwashes; Oral Hygiene; Pneumonia, Ventilator-Associated; Randomized Controlled Trials as Topic; Respiration, Artificial; Toothbrushing
PubMed: 33368159
DOI: 10.1002/14651858.CD008367.pub4 -
The Cochrane Database of Systematic... Jun 2014Removing dental plaque may play a key role maintaining oral health. There is conflicting evidence for the relative merits of manual and powered toothbrushing in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Removing dental plaque may play a key role maintaining oral health. There is conflicting evidence for the relative merits of manual and powered toothbrushing in achieving this. This is an update of a Cochrane review first published in 2003, and previously updated in 2005.
OBJECTIVES
To compare manual and powered toothbrushes in everyday use, by people of any age, in relation to the removal of plaque, the health of the gingivae, staining and calculus, dependability, adverse effects and cost.
SEARCH METHODS
We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 23 January 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE via OVID (1946 to 23 January 2014), EMBASE via OVID (1980 to 23 January 2014) and CINAHL via EBSCO (1980 to 23 January 2014). We searched the US National Institutes of Health Trials Register and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
Randomised controlled trials of at least four weeks of unsupervised powered toothbrushing versus manual toothbrushing for oral health in children and adults.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by The Cochrane Collaboration. Random-effects models were used provided there were four or more studies included in the meta-analysis, otherwise fixed-effect models were used. Data were classed as short term (one to three months) and long term (greater than three months).
MAIN RESULTS
Fifty-six trials met the inclusion criteria; 51 trials involving 4624 participants provided data for meta-analysis. Five trials were at low risk of bias, five at high and 46 at unclear risk of bias.There is moderate quality evidence that powered toothbrushes provide a statistically significant benefit compared with manual toothbrushes with regard to the reduction of plaque in both the short term (standardised mean difference (SMD) -0.50 (95% confidence interval (CI) -0.70 to -0.31); 40 trials, n = 2871) and long term (SMD -0.47 (95% CI -0.82 to -0.11; 14 trials, n = 978). These results correspond to an 11% reduction in plaque for the Quigley Hein index (Turesky) in the short term and 21% reduction long term. Both meta-analyses showed high levels of heterogeneity (I(2) = 83% and 86% respectively) that was not explained by the different powered toothbrush type subgroups.With regard to gingivitis, there is moderate quality evidence that powered toothbrushes again provide a statistically significant benefit when compared with manual toothbrushes both in the short term (SMD -0.43 (95% CI -0.60 to -0.25); 44 trials, n = 3345) and long term (SMD -0.21 (95% CI -0.31 to -0.12); 16 trials, n = 1645). This corresponds to a 6% and 11% reduction in gingivitis for the Löe and Silness index respectively. Both meta-analyses showed high levels of heterogeneity (I(2) = 82% and 51% respectively) that was not explained by the different powered toothbrush type subgroups.The number of trials for each type of powered toothbrush varied: side to side (10 trials), counter oscillation (five trials), rotation oscillation (27 trials), circular (two trials), ultrasonic (seven trials), ionic (four trials) and unknown (five trials). The greatest body of evidence was for rotation oscillation brushes which demonstrated a statistically significant reduction in plaque and gingivitis at both time points.
AUTHORS' CONCLUSIONS
Powered toothbrushes reduce plaque and gingivitis more than manual toothbrushing in the short and long term. The clinical importance of these findings remains unclear. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.Cost, reliability and side effects were inconsistently reported. Any reported side effects were localised and only temporary.
Topics: Dental Devices, Home Care; Dental Plaque; Gingival Diseases; Gingivitis; Humans; Oral Health; Periodontal Diseases; Randomized Controlled Trials as Topic; Toothbrushing
PubMed: 24934383
DOI: 10.1002/14651858.CD002281.pub3 -
International Journal of Dental Hygiene Feb 2022This systematic review and network meta-analysis synthesizes the available clinical evidence concerning efficacy with respect to plaque scores following a brushing... (Meta-Analysis)
Meta-Analysis Review
AIM
This systematic review and network meta-analysis synthesizes the available clinical evidence concerning efficacy with respect to plaque scores following a brushing action with oscillating-rotating (OR) or high-frequency sonic (HFS) powered toothbrushes (PTB) compared with a manual toothbrush (MTB) as control.
MATERIAL AND METHODS
Databases were searched up to 1 August 2021, for clinical trials that evaluated the efficacy of a PTB with OR or HFS technology compared with an MTB on plaque removal after a single-brushing action and conducted with healthy adult patients. Meta-analysis (MA) and a network meta-analysis (NMA) were performed.
RESULTS
Twenty-eight eligible publications, including 56 relevant comparisons, were retrieved. The overall NMA results for the mean post-brushing score showed a statistically significant difference for the comparison between an OR PTB and an MTB (SMD = -0.43; 95% CI [-0.696;-0.171]). The change in plaque score data showed a significant effect of a PTB over an MTB and OR over HFS. Based on ranking, the OR PTB was highest, followed by the HFS PTB and the MTB.
CONCLUSION
Within the limitations of the present study design, based on the outcome following a single-brushing action, it can be concluded that for dental plaque removal, there is a high certainty for a small effect of a PTB over an MTB. This supports the recommendation to use a powered toothbrush for daily plaque removal. There is moderate certainty for a very small benefit for the use of a powered toothbrush with an OR over an HFS mode of action.
Topics: Adult; Dental Plaque; Dental Plaque Index; Equipment Design; Humans; Network Meta-Analysis; Single-Blind Method; Toothbrushing
PubMed: 34877772
DOI: 10.1111/idh.12563 -
The Chinese Journal of Dental Research 2017To analyse factors associated with the susceptibility of early childhood caries (ECC), populations with a high risk of ECC were screened and guidance for ECC prevention...
OBJECTIVE
To analyse factors associated with the susceptibility of early childhood caries (ECC), populations with a high risk of ECC were screened and guidance for ECC prevention was proposed.
METHODS
A total of 392 children aged 24 to 71 months were selected for oral examination in Qingdao. Parents or guardians of the participants completed the questionnaires and decayed missing filled surface (dmfs) were recorded. Differences in caries condition and oral health behaviour in different families were compared. Risk factors related to ECC were screened. The subjects were finally grouped based on the obtained dmfs into three groups: caries-free, ECC and S-ECC (severe ECC). Association of risk factors with the caries status was analysed using the Kruskal-Wallis test, the chi-square test and logistic regression analysis.
RESULTS
There were significant differences among the caries-free, ECC and S-ECC groups in three parameters: eating too many sweets each day, brushing before and after sleeping, and whether parents helped to brush (P < 0.01). Combined factors such as the parents' level of education, oral health knowledge, attitudes, the family's annual income, the age of children when they start to brush and not brushing regularly were also significantly related to ECC (P < 0.05). No significant differences were observed among the three groups for these factors, including birth condition and nursing state, physical condition of the mother during pregnancy, feeding situation, if a pacifier was used during sleep, duration of brushing, frequency of mouth rinsing after meals each day and brushing with fluoride toothpaste (P > 0.05).
CONCLUSION
Eating a lot of sweets, an incorrect brushing method, starting brushing at a later stage and not brushing regularly are susceptible factors for ECC. Emphasising oral health knowledge to parents and guardians, conducting proper brushing methods, limiting the frequency of sweets being eaten and avoiding an inappropriate habit of eating sweets are very important factors in the prevention of ECC.
Topics: Child, Preschool; China; Dental Caries; Dietary Sucrose; Female; Humans; Male; Risk Factors; Toothbrushing
PubMed: 28573263
DOI: 10.3290/j.cjdr.a38274 -
Indian Journal of Dental Research :... 2019To evaluate the effectiveness of school dental health education on the oral health status, oral health-related knowledge, and practice behavior of 6-12-year-old children.
OBJECTIVE
To evaluate the effectiveness of school dental health education on the oral health status, oral health-related knowledge, and practice behavior of 6-12-year-old children.
METHODS
Hand search and electronic search based on the keywords on school dental health education in seven search engines till 2017 identified 7434 articles. Trials involving school-based dental health education with a minimum follow-up period of 6 months were screened. Risk of bias assessment was done independently by two authors.
RESULTS
Among the 18 articles which fulfilled the eligibility criteria, six were randomized controlled trials (RCTs) and 12 were non-RCTs. Quality assessment showed that 12 trials had a low risk of bias. Oral health-related knowledge improved in children. Oral health-related practice behaviors such as frequency and duration of brushing improved. Use of fluoridated toothpaste was increased. Plaque scores and gingival bleeding scores reduced.
CONCLUSION
School dental health education had a positive impact on the oral health status, knowledge, and practice behavior of children. There is a definite need for high-quality RCTs analyzing the effectiveness of school dental health education on specific oral health outcomes.
Topics: Child; Health Education, Dental; Humans; Oral Health; Periodontal Index; Randomized Controlled Trials as Topic; Schools; Toothbrushing
PubMed: 31397422
DOI: 10.4103/ijdr.IJDR_805_18 -
The Cochrane Database of Systematic... Dec 2019Halitosis or bad breath is a symptom in which a noticeably unpleasant breath odour is present due to an underlying oral or systemic disease. 50% to 60% of the world... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Halitosis or bad breath is a symptom in which a noticeably unpleasant breath odour is present due to an underlying oral or systemic disease. 50% to 60% of the world population has experienced this problem which can lead to social stigma and loss of self-confidence. Multiple interventions have been tried to control halitosis ranging from mouthwashes and toothpastes to lasers. This new Cochrane Review incorporates Cochrane Reviews previously published on tongue scraping and mouthrinses for halitosis.
OBJECTIVES
The objectives of this review were to assess the effects of various interventions used to control halitosis due to oral diseases only. We excluded studies including patients with halitosis secondary to systemic disease and halitosis-masking interventions.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 April 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 3) in the Cochrane Library (searched 8 April 2019), MEDLINE Ovid (1946 to 8 April 2019), and Embase Ovid (1980 to 8 April 2019). We also searched LILACS BIREME (1982 to 19 April 2019), the National Database of Indian Medical Journals (1985 to 19 April 2019), OpenGrey (1992 to 19 April 2019), and CINAHL EBSCO (1937 to 19 April 2019). The US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (8 April 2019), the World Health Organization International Clinical Trials Registry Platform (8 April 2019), the ISRCTN Registry (19 April 2019), the Clinical Trials Registry - India (19 April 2019), were searched for ongoing trials. We also searched the cross-references of included studies and systematic reviews published on the topic. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) which involved adults over the age of 16, and any intervention for managing halitosis compared to another or placebo, or no intervention. The active interventions or controls were administered over a minimum of one week and with no upper time limit. We excluded quasi-randomised trials, trials comparing the results for less than one week follow-up, and studies including advanced periodontitis.
DATA COLLECTION AND ANALYSIS
Two pairs of review authors independently selected trials, extracted data, and assessed risk of bias. We estimated mean differences (MDs) for continuous data, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach.
MAIN RESULTS
We included 44 trials in the review with 1809 participants comparing an intervention with a placebo or a control. The age of participants ranged from 17 to 77 years. Most of the trials reported on short-term follow-up (ranging from one week to four weeks). Only one trial reported long-term follow-up (three months). Three studies were at low overall risk of bias, 16 at high overall risk of bias, and the remaining 25 at unclear overall risk of bias. We compared different types of interventions which were categorised as mechanical debridement, chewing gums, systemic deodorising agents, topical agents, toothpastes, mouthrinse/mouthwash, tablets, and combination methods. Mechanical debridement: for mechanical tongue cleaning versus no tongue cleaning, the evidence was very uncertain for the outcome dentist-reported organoleptic test (OLT) scores (MD -0.20, 95% CI -0.34 to -0.07; 2 trials, 46 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Chewing gums: for 0.6% eucalyptus chewing gum versus placebo chewing gum, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.10, 95% CI -0.31 to 0.11; 1 trial, 65 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Systemic deodorising agents: for 1000 mg champignon versus placebo, the evidence was very uncertain for the outcome patient-reported visual analogue scale (VAS) scores (MD -1.07, 95% CI -14.51 to 12.37; 1 trial, 40 participants; very low-certainty evidence). No data were reported for dentist-reported OLT score or adverse events. Topical agents: for hinokitiol gel versus placebo gel, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.27, 95% CI -1.26 to 0.72; 1 trial, 18 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Toothpastes: for 0.3% triclosan toothpaste versus control toothpaste, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -3.48, 95% CI -3.77 to -3.19; 1 trial, 81 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Mouthrinse/mouthwash: for mouthwash containing chlorhexidine and zinc acetate versus placebo mouthwash, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.20, 95% CI -0.58 to 0.18; 1 trial, 44 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Tablets: no data were reported on key outcomes for this comparison. Combination methods: for brushing plus cetylpyridium mouthwash versus brushing, the evidence was uncertain for the outcome dentist-reported OLT scores (MD -0.48, 95% CI -0.72 to -0.24; 1 trial, 70 participants; low-certainty evidence). No data were reported for patient-reported OLT score or adverse events.
AUTHORS' CONCLUSIONS
We found low- to very low-certainty evidence to support the effectiveness of interventions for managing halitosis compared to placebo or control for the OLT and patient-reported outcomes tested. We were unable to draw any conclusions regarding the superiority of any intervention or concentration. Well-planned RCTs need to be conducted by standardising the interventions and concentrations.
Topics: Adolescent; Adult; Aged; Chewing Gum; Chlorhexidine; Dental Scaling; Female; Halitosis; Humans; Male; Middle Aged; Mouthwashes; Oral Health; Oral Hygiene; Randomized Controlled Trials as Topic; Tongue; Toothbrushing; Toothpastes; Young Adult
PubMed: 31825092
DOI: 10.1002/14651858.CD012213.pub2 -
Caries Research 2019The World Health Organization guideline to use less sugar may be an opportunity and support for dentistry in its goal to get the message of using less sugar across to... (Review)
Review
The World Health Organization guideline to use less sugar may be an opportunity and support for dentistry in its goal to get the message of using less sugar across to the public. Two ways (with all the combinations of these) to achieve a reduction of sugar consumption are the reduction of the amount of sugar in products or the reduction of the frequency of consumption of sugar-containing products. Which sugar-reducing strategy is best for caries prevention? To answer this question, this manuscript discusses the shape of the dose-response association between sugar intake and caries, the influence of fluoridated toothpaste on the association of sugar intake and caries and the relative contribution of frequency and amount of sugar intake to caries levels. The results suggest that when fluoride is appropriately used, the relation between sugar consumption and caries is very low or absent. The high correlation between amount and frequency hampers the decision related to which of both is of more importance, but frequency (and stickiness) fits better in our understanding of the caries process. Reducing the amount without reducing the frequency does not seem to be an effective caries preventive approach in contrast to the reciprocity. Goals set in terms of frequency may also be more tangible for patients to follow than goals set in amount. Yet, in sessions of dietary counselling to prevent dental caries, the counsellor should not forget the importance of quality tooth brushing with fluoride toothpaste.
Topics: Dental Caries; Dietary Sugars; Fluorides; Humans; Sugars; Toothbrushing; Toothpastes
PubMed: 30089285
DOI: 10.1159/000489571 -
The Cochrane Database of Systematic... Oct 2016Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Ventilator-associated pneumonia (VAP) is defined as pneumonia developing in people who have received mechanical ventilation for at least 48 hours. VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care (OHC), using either a mouthrinse, gel, toothbrush, or combination, together with aspiration of secretions, may reduce the risk of VAP in these patients.
OBJECTIVES
To assess the effects of oral hygiene care on incidence of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation in hospital intensive care units (ICUs).
SEARCH METHODS
We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 17 December 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2015, Issue 11), MEDLINE Ovid (1946 to 17 December 2015), Embase Ovid (1980 to 17 December 2015), LILACS BIREME Virtual Health Library (1982 to 17 December 2015), CINAHL EBSCO (1937 to 17 December 2016), Chinese Biomedical Literature Database (1978 to 14 January 2013), China National Knowledge Infrastructure (1994 to 14 January 2013), Wan Fang Database (January 1984 to 14 January 2013) and VIP Database (January 2012 to 4 May 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 17 December 2015. We placed no restrictions on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) evaluating the effects of OHC (mouthrinse, swab, toothbrush or combination) in critically ill patients receiving mechanical ventilation for at least 48 hours.
DATA COLLECTION AND ANALYSIS
At least two review authors independently assessed search results, extracted data and assessed risk of bias in included studies. We contacted study authors for additional information. We pooled data from trials with similar interventions and outcomes. We reported risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, using random-effects models unless there were fewer than four studies.
MAIN RESULTS
We included 38 RCTs (6016 participants). There were four main comparisons: chlorhexidine (CHX) mouthrinse or gel versus placebo/usual care; toothbrushing versus no toothbrushing; powered versus manual toothbrushing; and comparisons of oral care solutions. We assessed the overall risk of bias as low in five trials (13%), high in 26 trials (68%), and unclear in seven trials (18%). We did not consider the risk of bias to be serious when assessing the quality of evidence (GRADE) for VAP incidence, but we downgraded other outcomes for risk of bias.High quality evidence from 18 RCTs (2451 participants, 86% adults) shows that CHX mouthrinse or gel, as part of OHC, reduces the risk of VAP compared to placebo or usual care from 25% to about 19% (RR 0.74, 95% confidence intervals (CI) 0.61 to 0.89, P = 0.002, I = 31%). This is equivalent to a number needed to treat for an additional beneficial outcome (NNTB) of 17 (95% CI 10 to 33), which indicates that for every 17 ventilated patients in intensive care receiving OHC including chlorhexidine, one outcome of VAP would be prevented. There is no evidence of a difference between CHX and placebo/usual care for the outcomes of mortality (RR 1.09, 95% CI 0.96 to 1.23, P = 0.18, I = 0%, 15 RCTs, 2163 participants, moderate quality evidence), duration of mechanical ventilation (MD -0.09 days, 95% CI -1.73 to 1.55 days, P = 0.91, I = 36%, five RCTs, 800 participants, low quality evidence), or duration of intensive care unit (ICU) stay (MD 0.21 days, 95% CI -1.48 to 1.89 days, P = 0.81, I = 9%, six RCTs, 833 participants, moderate quality evidence). There is insufficient evidence to determine the effect of CHX on duration of systemic antibiotics, oral health indices, caregivers' preferences or cost. Only two studies reported any adverse effects, and these were mild with similar frequency in CHX and control groups.We are uncertain as to the effects of toothbrushing (± antiseptics) on the outcomes of VAP (RR 0.69, 95% CI 0.44 to 1.09, P = 0.11, I = 64%, five RCTs, 889 participants, very low quality evidence) and mortality (RR 0.87, 95% CI 0.70 to 1.09, P = 0.24, I = 0%, five RCTs, 889 participants, low quality evidence) compared to OHC without toothbrushing (± antiseptics). There is insufficient evidence to determine whether toothbrushing affects duration of mechanical ventilation, duration of ICU stay, use of systemic antibiotics, oral health indices, adverse effects, caregivers' preferences or cost.Only one trial (78 participants) compared use of a powered toothbrush with a manual toothbrush, providing insufficient evidence to determine the effect on any of the outcomes of this review.Fifteen trials compared various other oral care solutions. There is very weak evidence that povidone iodine mouthrinse is more effective than saline/placebo (RR 0.69, 95% CI 0.50 to 0.95, P = 0.02, I = 74%, three studies, 356 participants, high risk of bias), and that saline rinse is more effective than saline swab (RR 0.47, 95% CI 0.37 to 0.62, P < 0.001, I = 84%, four studies, 488 participants, high risk of bias) in reducing VAP. Due to variation in comparisons and outcomes among trials, there is insufficient evidence concerning the effects of other oral care solutions.
AUTHORS' CONCLUSIONS
OHC including chlorhexidine mouthwash or gel reduces the risk of developing ventilator-associated pneumonia in critically ill patients from 25% to about 19%. However, there is no evidence of a difference in the outcomes of mortality, duration of mechanical ventilation or duration of ICU stay. There is no evidence that OHC including both antiseptics and toothbrushing is different from OHC with antiseptics alone, and some weak evidence to suggest that povidone iodine mouthrinse is more effective than saline/placebo, and saline rinse is more effective than saline swab in reducing VAP. There is insufficient evidence to determine whether powered toothbrushing or other oral care solutions are effective in reducing VAP. There is also insufficient evidence to determine whether any of the interventions evaluated in the studies are associated with adverse effects.
Topics: Adult; Child; Chlorhexidine; Critical Illness; Humans; Intensive Care Units; Mouthwashes; Oral Hygiene; Pneumonia, Ventilator-Associated; Randomized Controlled Trials as Topic; Respiration, Artificial; Toothbrushing
PubMed: 27778318
DOI: 10.1002/14651858.CD008367.pub3 -
Ciencia & Saude Coletiva 2019This study investigated the mediation of self-esteem in adolescents' oral health behaviors. The Rosenberg self-esteem scale was used to assess self-esteem, whereas data...
This study investigated the mediation of self-esteem in adolescents' oral health behaviors. The Rosenberg self-esteem scale was used to assess self-esteem, whereas data from socio-demographic and behavior characteristics were analyzed by questions validated in previous surveys. The teenagers had good oral health behavior, except unhealthy diet. The number of adolescents with high self-esteem was a lot smaller than those with low self-esteem. The use of dental services, even when associated with high self-esteem, lost significance after being adjusted by sex, age and tooth brushing frequency. Nevertheless, multiple logistic regression analysis, using unadjusted estimates and adjusted with their respective Confidence Intervals of 95%, showed a relationship of self-esteem with age (p-value=0.001) and tooth brushing frequency (p-value=0.019). Regardless of the sex, students over 16 years old with high self-esteem brush their teeth more often, having probably better oral health. These results confirm the modulation of self-esteem in oral health, and then it is necessary the analysis and the use of these psychosocial factors in the young oral health care.
Topics: Adolescent; Age Factors; Cross-Sectional Studies; Dental Care; Diet; Female; Health Behavior; Humans; Male; Oral Health; Self Concept; Students; Surveys and Questionnaires; Toothbrushing; Young Adult
PubMed: 31664381
DOI: 10.1590/1413-812320182411.02492018 -
Community Dentistry and Oral... Oct 2018To examine the association between consumption frequency of foods and drinks with added sugar and dental caries experience in the permanent teeth of 12- and 15-year-old...
OBJECTIVES
To examine the association between consumption frequency of foods and drinks with added sugar and dental caries experience in the permanent teeth of 12- and 15-year-old children in England, Wales and Northern Ireland, using the Children's Dental Health Survey 2013 (CDHS) data.
METHODS
Four thousand nine hundred and fifty children aged 12 and 15 have the following information available: daily consumption frequency of foods and drinks with added sugar, tooth-brushing frequency, dental attendance, and water-drinking frequency. The children's dental caries experience was available as a DMFT score (number of decayed, missing, filled permanent teeth). A zero-inflated negative binomial model (ZINB) was used to fit the DMFT score.
RESULTS
Lower socioeconomic status (SES), nonregular dental check-ups, and low water-drinking frequency were associated with higher consumption frequency of added sugar (all P < 0.05). The consumption frequency of both drinks and foods with added sugar also differed by region (P < 0.001), and children who more frequently consumed foods with added sugars also consumed drinks with added sugars more often (P < 0.001). Using the Zero-Inflated Negative Binomial model, DMFT scores were not associated with consumption frequency of added sugars for children with caries (DMFT > 0), but the chance of being free of obvious caries (DMFT = 0) was lower for children with high frequency (≥4) of sugar-added foods than for children reported to have a sugar-free diet (OR = 0.5, 95% CI [0.3, 0.8]).
CONCLUSIONS
Consumption frequency of added sugars was associated with dental caries and a number of child demographic and lifestyle characteristics. Children who consume foods and drinks with added sugar more frequently are more likely to develop dental caries, but higher consumption frequency of drinking water in fluoridated areas might reduce dental caries. The findings add to the evidence for the association between children's dental caries and added sugar consumption.
Topics: Adolescent; Child; DMF Index; Dental Caries; Diet; Dietary Sugars; Female; Humans; Male; Risk Factors; Toothbrushing; United Kingdom
PubMed: 30125961
DOI: 10.1111/cdoe.12413