Impacts of intensive care patients' oral hygiene on nosocomial and ventilator-associated pneumonia: integrative literature review




Hospital dental staff; Dentistry; Intensive Care Unit; Oral hygiene.


Hospital Dentistry has been gaining field, since several successful experiences, associated with scientific evidence have shown that dental care at the hospital level can contribute to the reduction of cases of nosocomial pneumonia associated with mechanical ventilation, thus reducing the length of hospital stay and consequently the costs of this process. The objective of this study was to verify the efficacy of oral hygiene protocols in ICU patients in the prevention of ventilator-associated pneumonia or nosocomial pneumonia. An integrative literature review was carried out with searches in the Pubmed/MEDLINE and Scielo databases, in which 23 articles were selected for qualitative analysis after application of the eligibility criteria guided by the PRISMA strategy. We noticed that the use of chlorhexidine seems to be the most recurrent protocol in the studies, with better results when associated with the mechanical adequacy provided by brushing, in reducing the cases of nosocomial pneumonia. Other methods such as the use of povidone-iodine and supraglottic aspiration were mentioned, although their effects are still controversial. Thus, we conclude that although there is not a well-defined protocol for the control of oral biofilm and consequent reduction in the prevalence of pneumonia, chlorhexidine associated with brushing seems to be the most promising method. More studies with robust methodology are needed for the understanding and proposal of protocols based on scientific evidence for oral hygiene of patients in intensive care, focused on reducing morbidity and mortality from nosocomial pneumonia.

Author Biographies

Gabriel Borges Di Paolo, Centro Universitário de Patos de Minas

Acadêmico do curso de graduação em Odontologia do Centro Universitário de Patos de Minas, Patos de Minas, MG, Brasil. 

Carolina Silva Pereira, Centro Universitário de Patos de Minas

Acadêmica do curso de graduação em Odontologia do Centro Universitário de Patos de Minas, Patos de Minas, MG, Brasil. 


Anisio Rodiney Souza Júnior, Centro Universitário de Patos de Minas

Acadêmico do curso de graduação em Odontologia do Centro Universitário de Patos de Minas, Patos de Minas, MG, Brasil. 

Fabrício Campos Machado, Centro Universitário de Patos de Minas

Docente do Curso de Odontologia do Centro Universitário de Patos de Minas (UNIPAM), Patos de Minas, MG, Brasil. 

Thiago de Amorim Carvalho, Centro Universitário de Patos de Minas

Docente do curso de graduação de Odontologia do Centro Universitário de Patos de Minas (UNIPAM), Patos de Minas, MG, Brasil. 


Alecrim, R. X., Taminato, M., Belasco, A., Longo, M. C. B., Kusahara, D. M. & Fram, D. (2019). Strategies for preventing ventilator-associated pneumonia: an integrative review. Rev Bras Enferm.72(2):521-530. 10.1590/0034-7167-2018-0473.

Bao, L., Zhang, C., Dong, J., Zhao, L., Li, Y. & Sun, J. (2020). Oral Microbiome and SARSCoV-2: Beware of Lung Co-infection. Front Microbiol. 31;11:1840. 10.3389/fmicb.2020.01840.

Bellissimo-Rodrigues, W. T., Menegueti, M. G., Gaspar, G. G., Nicolini, E. A., Auxiliadora-Martins, M., Basile-Filho, A., Martinez, R. & Bellissimo-Rodrigues, F. (2014). Effectiveness of a dental care intervention in the prevention of lower respiratory tract nosocomial infections among intensive care patients: a randomized clinical trial. Infect Control Hosp Epidemiol. 35(11):1342-8. 10.1086/678427.

CDC. Centre For Disease Prevention and Control. (2020). Interim guidance for environmental cleaning in non-healthcare facilities exposed to SARS-CoV-2. Disponível em:

CFO. Recomendações AMIB/CFO para atendimento odontológico COVID- 19 em UTI: Comitê de Odontologia AMIB/CFO de enfrentamento ao COVID-19. (2021) Departamento de Odontologia AMIB, 4ed. Disponível em:

CFO. Resolução CFO-162/2015. (2015). Reconhece o exercício da Odontologia Hospitalar pelo cirurgião-dentista. Rio de Janeiro, R.J. Disponível em:

Collina G. A. da, Tempestini-Horliana, A. C. R., Silva, D. F. T. da, Longo, P. L., Makabe, M. L. F. & Pavani, C. (2017). Oral hygiene in intensive care unit patients with photodynamic therapy: study protocol for randomised controlled trial. Trials. 18(1):385. 10.1186/s13063-017-2133-y.

El-Rabbany, M., Zaghlol, N., Bhandari, M. & Azarpazhooh, A. (2015). Prophylactic oral health procedures to prevent hospital-acquired and ventilator-associated pneumonia: a systematic review. Int J Nurs Stud. 52(1):452-64. 10.1016/j.ijnurstu.2014.07.010.

Guerra, F., De Martino, F., Capocci, M., Rinaldo, F., Mannocci, A., De Biase, A., Ottolenghi, L. & La Torre, G. VAP and oral hygiene.A systematic review. Clin Ter. 167(6):198-205. 10.7417/CT.2016.1973.

Güler E. K. & Türk G. (2019) Oral Chlorhexidine Against Ventilator-Associated Pneumonia and Microbial Colonization in Intensive Care Patients. West J Nurs Res. 41(6):901-919. 10.1177/0193945918781531.

Haghighi, A., Shafipour,V., Bagheri-Nesami, M., Gholipour Baradari, A. & Yazdani Charati, J. (2017)The impact of oral care on oral health status and prevention of ventilator-associated pneumonia in critically ill patients. Aust Crit Care. 30(2):69-73. 10.1016/j.aucc.2016.07.002.

Hayashida, S., Funahara, M., Sekino, M., Yamaguchi, N., Kosai, K., Yanamoto, S., Yanagihara, K. & Umeda, M. (2016). The effect of tooth brushing, irrigation, and topical tetracycline administration on the reduction of oral bacteria in mechanically ventilated patients: a preliminary study. BMC Oral Health. 16(1):67. 10.1186/s12903-016-0224-x.

Hua, F., Xie, H., Worthington, H. V., Furness, S., Zhang, Q. & Li, C. (2016). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 10(10):CD008367. 10.1002/14651858.CD008367.pub3.

Jerônimo, L. S., Abreu, L. G., Cunha, F. A. & Lima, R. P. E. (2020). Association Between Periodontitis and Nosocomial Pneumonia: A Systematic Review and Meta-analysis of Observational Studies. Oral Health Prev Dent. 18(1):11-17. 10.3290/j.ohpd.a44114.

Keyt H., Faverio, P. & Restrepo, M. I. (2014). Prevention of ventilator-associated pneumonia in the intensive care unit: a review of the clinically relevant recent advancements. Indian J Med Res.139(6):814-21. Recuperado de:

Klompas, M. (2019). Prevention of Intensive Care Unit-Acquired Pneumonia. Semin Respir Crit Care Med. 40(4):548-557. 10.1055/s-0039-1695783.

Lacerda Vidal, C. F., Vidal, A. K., Monteiro, J. G. Jr, Cavalcanti, A., Henriques, A. P. C., Oliveira, M., Godoy, M., [...] & Lacerda, H.R. Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study. BMC Infect Dis. 17(1):112. 10.1186/s12879-017-2188-0.

Lee, S., Lighvan, N. L., McCredie, V., Pechlivanoglou, P., Krahn, M., Quiñonez, C. & Azarpazhooh, A. (2019). Chlorhexidine-Related Mortality Rate in Critically Ill Subjects in Intensive Care Units: A Systematic Review and Meta-Analysis. Respir Care. 64(3):337-349. 10.4187/respcare.06434.

McCue, M. K. & Palmer, G. A. (2019). Use of Chlorhexidine to Prevent Ventilator-Associated Pneumonia in a Long-term Care Setting: A Retrospective Medical Record Review. J Nurs Care Qual. 34(3):263-268. 10.1097/NCQ.0000000000000367.

Mendes, K. S., Silveira, R. S., Pereira, C. S., Galvão, C. M. (2008). Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto contexto – enferm. 17(4):758-764. Available from:

Rabello, F., Araújo, V. E. & Magalhães, S. (2018). Effectiveness of oral chlorhexidine for the prevention of nosocomial pneumonia and ventilator-associated pneumonia in intensive care units: Overview of systematic reviews. Int J Dent Hyg. 16(4):441-449. 10.1111/idh.12336.

Santi, S., S. & Santos, R. B. (2016). A prevalência da pneumonia nosocomial e sua relação com a doença periodontal: revisão de literatura. Revista Da Faculdade De Odontologia - UPF, 21(2).

Santos, O. M. dos, Carvalho, L. de S. L., Pita, R. T. S., Pereira, L. S., Almeida, S. P. de, Ramos, H. M. P., & Toledo, M. M. (2020). Fake News na Pandemia da Covid-19: um desserviço à sociedade brasileira. Revista Cenas Educacionais, 3(e9300),1-16.

Silvestri, L., Weir, W. I., Gregori, D., Taylor, N., Zandstra, D. F., van Saene, J. J. M. & van Saene, H. K. F. (2017). Impact of Oral Chlorhexidine on Bloodstream Infection in Critically Ill Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Cardiothorac Vasc Anesth. 31(6):2236-2244. 10.1053/j.jvca.2016.11.005.

Takeyasu, Y., Yamane, G. Y., Tonogi, M., Watanabe, Y., Nishikubo, S., Serita, R. & Imura, K. (2014). Ventilator-associated pneumonia risk decreased by use of oral moisture gel in oral health care. Bull Tokyo Dent Coll. 55(2):95-102. 10.2209/tdcpublication.55.95.

Tsuda, S., Soutome, S., Hayashida, S., Funahara, M., Yanamoto, S. & Umeda, M. (2020). Topical povidone iodine inhibits bacterial growth in the oral cavity of patients on mechanical ventilation: a randomized controlled study. BMC Oral Health. 20(1):62. 10.1186/s12903-020-1043-7.

Viana, W. N., Bragazzi, C., Castro J. E. C. de, Alves, M. B. & Rocco, J. R. (2013). Ventilator-associated pneumonia prevention by education and two combined bedside strategies. Int J Qual Health Care. 25(3):308-13. 10.1093/intqhc/mzt025.

WHO. World Health Organization. (‎2020)‎. Clinical management of severe acute respiratory infection when novel coronavirus (‎2019-nCoV)‎ infection is suspected: interim guidance.

Yao, L. Y., Chang, C. K., Maa, S. H., Wang, C. & Chen, C. C. (2011). Brushing teeth with purified water to reduce ventilator-associated pneumonia. J Nurs Res. 19(4):289-97. 10.1097/JNR.0b013e318236d05f.

Zhang, T. T., Tang, S. S. & Fu, L. J. (2014). The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. J Clin Nurs. 23(11-12):1461-75. 10.1111/jocn.12312.

Zhao, T., Wu, X., Zhang, Q., Li, C., Worthington, H. V. & Hua F. (2020). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev.12:CD008367. 10.1002/14651858.CD008367.pub4.



How to Cite

DI PAOLO, G. B.; PEREIRA, C. S.; SOUZA JÚNIOR, A. R.; MACHADO, F. C.; CARVALHO, T. de A. . Impacts of intensive care patients’ oral hygiene on nosocomial and ventilator-associated pneumonia: integrative literature review. Research, Society and Development, [S. l.], v. 10, n. 13, p. e376101321586, 2021. DOI: 10.33448/rsd-v10i13.21586. Disponível em: Acesso em: 8 dec. 2021.



Review Article