Table 1 Research priorities in the field of oral hygiene for ICU patients

From: Less daily oral hygiene is more in the ICU: not sure

Topic Focus and outcome Suggested approach and points of interest
Oral assessment Oral assessment tool for ICU patients
Outcome: separate tools for intubated and non-intubated patients, respectively
Development—reliability and validity testing. Multidisciplinary cooperation with dental professionals
Type of toothbrush Manual versus powered
Bristle size, shape and type
Outcome: plaque reduction
Randomized controlled trial (RCT). Blinding not possible—cave performance bias, same oral care regimens in comparable groups. Independent blinded assessment of outcomes and assessment of compliance highly recommended. Consider use of split-mouth design
Mouthwashes Chlorhexidine gluconate
Outcome: safety
Preclinical trials on toxicity and pharmacokinetics. No RCTs given the current state of the science
  Alternatives to CHG including povidone iodine, saline, bicarbonate, triclosan and furacilin
Outcome: effectiveness in chemically cleaning the oral cavity
Separate randomized controlled trials or multiple-armed RCTs or factorial design. Cave, the latter rely on the assumption of no interaction between treatment arms. Avoid split mouth design due to the high possibility of carry-across effects
Solutions for moistening the oral cavity Saliva substitutes and oral moisturizers
Outcome: effectiveness in hydrating the oral cavity and lips
Same as above
Frequency Optimal frequency for various aspects of daily oral hygiene (teeth brushing, moisturizing, mouthwash)
Outcome: oral health as measured through specific, valid and reliable oral assessment tools for intubated and non-intubated ICU patients, respectively
Valid and reliable oral assessment tool needs to be developed first. Then, separate randomized controlled trials or multiple armed RCTs or factorial design. Cave, the latter rely on the assumption of no interaction between treatment arms
Best practices for ICU patients with specific oral needs Best oral hygiene practices for patients with, e.g. dental prostheses, following maxillofacial surgery, oral health problems, … Multidisciplinary cooperation with dental professionals