Researchers have found in new research that addition of toothbrushing to routine chlorhexidine oral care did not significantly reduce the incidence of ventilator-associated pneumonia (VAP) or mortality. However, a consistent trend toward clinical benefit was observed, including fewer positive sputum cultures, reduced need for inotropic support, and fewer new pulmonary infiltrates. The findings suggest that enhanced oral hygiene may benefit critically ill children in the PICU, warranting confirmation through larger multicentre studies.
The study was published in the journal BMC Pediatrics by Ahmed R. and colleagues. In order to evaluate the efficacy of mechanical toothbrushing in addition to chemical decontamination when compared with chemical decontamination alone, the authors of this study performed a randomized controlled trial involving 118 children between the ages of 18 months and 16 years. All participants involved in this study had been admitted to the pediatric intensive care unit and were being treated with invasive mechanical ventilation for more than 48 hours.
On admission, the patients were randomly divided into two equal groups, the intervention group having mechanical tooth brushing in addition to 0.12% of chlorhexidine mouth rinse as their oral care regimen and the control group had 0.12% chlorhexidine mouth rinse alone as routine care, both procedures done thrice a day.
Key findings:
- VAP occurred in 31 patients (52.5%) of the control group and in 25 patients (42.3%) of the intervention group.
- This suggests that tooth brushing with chlorhexidine may help in preventing VAP; however, the obtained difference did not reach a level of statistical significance (p = 0.36).
- In total, among all studied patients, 45.8% died, and 54.2% were discharged from the hospital.
- The mortality percentage was higher in the control group (53.7%) in comparison with the intervention group (46.3%), while the discharge percentage was higher in the intervention group (53.1%) versus the control group (46.9%), but no statistical significance was found (p = 0.46).
- In addition, it was found that sputum cultures were mostly positive in the control group (55.6%) compared to the intervention group (44.4%), while negative cultures were more frequent in the intervention group (54.7% vs. 45.3%), but the difference between the two groups was not significant (p = 0.268).
In summary, while the addition of toothbrushing to the standard chlorhexidine regimen had no statistically significant impact on the incidence or mortality of VAP, there were clear trends indicating that this approach was beneficial clinically in several ways, such as fewer positive cultures from sputum, reduced need for inotropic support, and fewer pulmonary infiltrates. Since toothbrushing is an inexpensive and safe procedure, including it in PICU nursing bundles is a sensible way to improve airway management in children.
Reference:
Rezk, A.R., Hassan, S.A., Abd Elhakam, R.M. et al. Tooth brushing versus routine oral care impact on ventilator-associated pneumonia in PICU: a clinical trial. BMC Pediatr 26, 683 (2026). https://doi.org/10.1186/s12887-026-07239-x
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