***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: INTRODUCTION Oral hygiene ( OH ) forms a part of the patient 's safety in the prevention of mechanical ventilator-associated pneumonia ( VAP ) . The dental plaque index ( DP ) is considered as a quality marker for OH . HYPOTHESIS The association of electric toothbrush and conventional OH in intubated patients decreases the DP and incidence of VAP . OBJECTIVE To verify the reduction of DP in patients receiving OH and electric toothbrush  and its association with to the decrease of VAP incidence . MATERIAL S AND METHODS A 3-year long r and omized , single blind and prospect i ve study conducted in a 14-bed polyvalent intensive care unit . Patients were included when there was more than 48hours of mechanical ventilation and no expected respiratory infection . Patients were r and omized into two groups : St and ard ( OH with chlorhexidine ) ( GS ) and Raspall ( St and ard OH with electric dental brush ) ( GR ) . The VAP was identified following clinical , medical and microbiological criteria . The DP and halitosis were observed daily . Oral and pharyngeal swabs were collected during the first 5 days . RESULTS 147 patients were included . Mean age was 53.9±17.5 . No significant differences were found in the VAP incidence between the two groups ( OR=0.78 ; 95 % IC , 0.36 - 1.68 ; p=0.56 ) . The relation between halitosis and DP was p=0.7 . The dental plaque index on the 5th day was 1.98 ( n=60 ) in GR and 2.04 ( n=57 ) in GS ( p=0.3 ) . The dental plaque index on the 10th day was 1.68 ( n=29 ) in GR and 1.91 ( n=32 ) in GS ( p=0.7 ) . CONCLUSIONS There is a tendency towards a decrease in the DP which is clearing in the GR group and no relation between VAP and greater DP or halitosis Introduction Dental plaque biofilms are colonized by respiratory pathogens in mechanically-ventilated intensive care unit patients . Thus , improvements in oral hygiene in these patients may prevent ventilator-associated pneumonia . The goal of this study was to determine the minimum frequency ( once or twice a day ) for 0.12 % chlorhexidine gluconate application necessary to reduce oral colonization by pathogens in 175 intubated patients in a trauma intensive care unit . Methods A r and omized , double-blind , placebo-controlled clinical trial tested oral topical 0.12 % chlorhexidine gluconate or placebo ( vehicle alone ) , applied once or twice a day by staff nurses . Quantitation of colonization of the oral cavity by respiratory pathogens ( teeth/denture/buccal mucosa ) was measured . Results Subjects were recruited from 1 March , 2004 until 30 November , 2007 . While 175 subjects were r and omized , microbiologic baseline data was available for 146 subjects , with 115 subjects having full outcome assessment after at least 48 hours .  Chlorhexidine reduced the number of Staphylococcus aureus , but not the total number of enterics , Pseudomonas or Acinetobacter in the dental plaque of test subjects . A non-significant reduction in pneumonia rate was noted in groups treated with chlorhexidine compared with the placebo group ( OR = 0.54 , 95 % CI : 0.23 to 1.25 , P = 0.15 ) . No evidence for resistance to chlorhexidine was noted , and no adverse events were observed . No differences were noted in microbiologic or clinical outcomes between treatment arms . Conclusions While decontamination of the oral cavity with chlorhexidine did not reduce the total number of potential respiratory pathogens , it did reduce the number of S. aureus in dental plaque of trauma intensive care patients .Trial Registration clinical trials.gov NCT00123123 Background : Oral care may decrease the development of  ventilator-associated pneumonia ( VAP ) and improve oral hygiene . However , little evidence is available to guide the development of oral care protocol s. The practical effect of toothbrushing on VAP development and oral health and hygiene improvement is inconclusive . Purpose : This study evaluated the effects in postneurosurgical , intensive care unit patients of brushing teeth twice daily with purified water on VAP rates and oral health or hygiene . Methods : This study conducted a r and omized controlled pilot trial . Patients consecutively admitted to the surgical intensive care unit at a suburban hospital in 2007 were invited to participate if they met two inclusion criteria : ( a ) under ventilator support for at least 48 to 72 hours and ( b ) no current pneumonia . Upon obtaining informed consent , subjects were r and omized into experimental and control groups . Both groups received usual hospital care , that is , daily oral care using cotton swabs . The experimental group additionally received a twice-daily oral care protocol of toothbrushing with purified water , elevating the head of the bed , and before- and -after hypopharyngeal suctioning . The control group also received twice-daily mock oral care ( elevating the head of the bed , moisturizing the lips , and before- and -after hypopharyngeal suctioning ) . VAP was defined by a clinical pulmonary infection score of > 6 . Oral hygiene and health was assessed after conclusion of the intervention . Results : Patients ( N = 53 ) were predominantly male ( 64.2 % ) , mean age was 60.6 years old , and most had received emergency surgery ( 75.5 % ) . After 7 days of toothbrushing with purified water , cumulative VAP rates were significantly lower in the experimental ( 17 % ) than in the control ( 71 % ; p < .05 ) group . The experimental group also had significantly better scores for oral health ( p < .05 ) and plaque index ( p < .01 ) . Conclusion / Implication for Practice : Findings suggest that , as an inexpensive alternative to existing protocol s , toothbrushing twice daily with purified water reduces VAP and improves oral health and hygiene Background Poor oral hygiene has been associated with ventilator-acquired pneumonia . Yet providing oral care for intubated patients is problematic . Furthermore , concerns that oral care could raise intracranial pressure ( ICP ) may cause nurses to use foam swabs to provide oral hygiene rather than tooth brushing as recommended by the American Association of Critical-Care Nurses . Evidence is needed to support the safety of toothbrushing during oral care . We therefore evaluated ICP and cerebral perfusion pressure ( CPP ) during oral care with a manual or electric toothbrush in intubated patients in a neuroscience intensive care unit ( ICU ) . Methods As part of a larger 2-year , prospect i ve , r and omized clinical trial , 47 adult neuroscience ICU patients with an ICP monitor received oral care with a manual or electric toothbrush .  ICP and CPP were recorded before , during , and after oral care over the first 72 h of admission . Results Groups did not differ significantly in age , gender , or severity of injury . Of 807 ICP and CPP measurements  obtained before , during , and after oral care , there were no significant differences in ICP ( P = 0.72 ) or CPP ( P = 0.68 ) between toothbrush methods . Analysis of pooled data from both groups revealed a significant difference across the three time points ( Wilks ’ lambda , 12.56 ; P < 0.001 ; partial η2 , 0.36 ) . ICP increased significantly ( mean difference , 1.7 mm Hg ) from before to during oral care ( P = 0.001 ) and decreased significantly ( mean difference , 2.1 mm Hg ) from during to after oral care ( P < 0.001 ) . Conclusions In the absence of preexisting intracranial hypertension during oral care , tooth brushing , regardless of method , was safely performed in intubated neuroscience ICU patients OBJECTIVES Oropharyngeal colonisation has been identified as a factor contributing to ventilator associated pneumonia ( VAP ) in the Intensive Care Unit ( ICU ) . We sought to develop a clinical practice guideline for providing oral hygiene in the critically ill . RESEARCH METHODOLOGY Following a systematic literature review a prospect ively derived consensus development conference was convened and sponsored by a clinical governance unit . RESULTS The consensus development conference generated 12 recommendations for tools and solutions ; frequency and duration of cleaning ; oral assessment tools and oral hygiene protocol s. These recommendations underwent a validation process . CONCLUSIONS In light of sparse high level evidence to inform guidelines , further research is needed inform clinical practice . Oral hygiene is a critical element of nursing care and a st and ardised approach has the potential to improve clinical outcomes Objective : To assess the prevalence of oral colonization by respiratory pathogens in a group of ICU patients , with specific attention to dental plaque and the oral mucosa . Design : Prospect i ve , nonr and omized study with age-matched controls . Setting s : Medical ICU in a tertiary-care Veterans Affairs Medical Center and a dental school outpatient preventive dentistry clinic . Patients : Nonconsecutive , unselected patients admitted to the medical ICU during a 2-month period ; controls were age-matched patients seen for the first time in the preventive dentistry clinic . Interventions : None . Measurements :  Oral hygienic status  was assessed in both groups using a semiquantitative system . Quantitative cultures of dental plaque and buccal mucosa were done within 12 hrs of medical ICU admission and every third day thereafter until discharge/death from the medical ICU . In controls , cultures of plaque and buccal mucosa were done on the initial visit only . Severity of illness of medical ICU patients was quantitated using the Acute Physiology and Chronic Health Evaluation ( APACHE II ) system and McCabe-Jackson criteria . Main Results : Oral hygiene of medical ICU patients was poor . These patients had a mean plaque score ( 1.9 ± 0.2 ) that was significantly greater than that same score seen in out patients of the preventive dentistry clinic ( 1.4 ± 0.1 ; p < .005 ) . Plaque and /or oral mucosa of 22 ( 65 % ) of 34 medical ICU patients were colonized by respiratory pathogens , in contrast to only four ( 16 % ) of 25 preventive dentistry clinic patients ( p < .005 ) . The potential respiratory pathogens cultured from medical ICU patients included methicillinresistant Staphylococcus aureus , Pseudomonas aeruginosa , and ten genera of Gram-negative bacilli . Colonization by respiratory pathogens was statistically associated with concomitant antibiotic therapy within the medical ICU group of patients , but not with severity of illness . Although medical ICU patients tended to have more dental plaque than preventive dentistry clinic patients , there was no statistically significant association noted between the presence of dental plaque and respiratory pathogen colonization . Conclusions : These findings suggest that bacteria commonly causing nosocomial pneumonia colonize the dental plaque and oral mucosa of intensive care patients . In many cases , this colonization occurs by large numbers of bacteria . Dental plaque may be an important reservoir of these pathogens in medical ICU patients . Efforts to improve oral hygiene in medical ICU patients could reduce plaque load and possibly reduce oropharyngeal colonization OBJECTIVE To study the dental status and colonization of dental plaque by aerobic pathogens and their relation with nosocomial infections in intensive care unit ( ICU ) patients . DESIGN A prospect i ve study in a medical ICU of a university-affiliated hospital . PATIENTS Consecutive patients admitted to the ICU during a 3-mo period . INTERVENTIONS Dental status was assessed by the same investigator using a score adapted from the " Caries-Absent-Occluded " ( CAO ) index ( referred to in the U.S. as DMFT [ Decayed-Missing-Filled Teeth ] index ) . The amount of dental plaque on premolars was assessed using a semiquantitative score . Quantitative cultures of dental plaque , nasal secretions , tracheal aspirates , and urine were done at admission ( day 0 ) and every fifth day until death or discharge . An additional study was done in eight patients to serially compare dental plaque , salivary , and tracheal aspirate cultures during a 2-wk period . MEASUREMENTS AND MAIN RESULTS Fifty-seven patients were included in the main study . Due to the variability in their ICU stay , 29 patients could be examined on day 0 only ( group A ) , 15 patients on days 0 and 5 ( group B ) , and 13 patients on days 0 , 5 , and 10 ( group C ) . The mean dental CAO score was 16 + /- 8 and did not change during the ICU stay . The dental plaque score was < or = 1 in 70 % of patients on day 0 ; > or = 2 in 50 % of patients on day 5 ; and > or = 2 in 90 % of patients on day 10 . Dental plaque cultures were positive at 10(3 ) colony-forming units/mL for aerobic pathogens in 23 % of patients on day 0 ; 39 % of patients on day 5 ; and 46 % of patients on day 10 . In groups B 
    Output:
    
Toothbrushing did not impact on length of ICU stay , or ICU or hospital mortality .
CONCLUSIONS In intubated , mechanically ventilated critically ill patients , toothbrushing did not significantly reduce the risk of ventilator-associated pneumonia overall .
Toothbrushing has no effect on mortality or length of stay .
Electric and manual toothbrushing seem to have similar effects .