A randomized trial of dental brushing for preventing ventilator-associated pneumonia

Chest. 2009 Aug;136(2):433-439. doi: 10.1378/chest.09-0706. Epub 2009 May 29.


Background: Poor oral hygiene is associated with respiratory pathogen colonization and secondary lung infection. The impact of adding electric toothbrushing to oral care in order to reduce ventilator-associated pneumonia (VAP) incidence is unknown.

Methods: The study design was a prospective, simple-blind, randomized trial of adult patients intubated for > 48 h. Controlling for exposure to antibiotic treatment, patients were randomized to oral care every 8 h with 0.12% chlorhexidine digluconate (standard group) or standard oral care plus electric toothbrushing (toothbrush group). VAP was documented by quantitative respiratory cultures. Mechanical ventilation (MV) duration, hospital ICU length of stay (LOS), antibiotic use, and hospital ICU mortality were secondary end points.

Results: The study was terminated after randomizing 147 patients (74 toothbrush group) in a scheduled interim analysis. The two groups were comparable at baseline. The toothbrush group and standard group had similar rates of suspected VAP (20.3% vs 24.7%; p = 0.55). After adjustment for severity of illness and admission diagnosis, the incidence of microbiologically documented VAP was also similar in the two groups (hazard ratio, 0.84; 95% confidence interval, 0.41 to 1.73). The groups did not differ significantly in mortality, antibiotic-free days, duration of MV, or hospital ICU LOS.

Conclusions: Our findings suggest that the addition of electric toothbrushing to standard oral care with 0.12% chlorhexidine digluconate is not effective for the prevention of VAP.

Trial registration: ClinicalTrials.gov Identifier: NCT00842478.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Anti-Infective Agents, Local / pharmacology*
  • Chlorhexidine / analogs & derivatives*
  • Chlorhexidine / pharmacology
  • Confidence Intervals
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Intensive Care Units
  • Male
  • Middle Aged
  • Odds Ratio
  • Oral Hygiene*
  • Pneumonia, Ventilator-Associated / epidemiology
  • Pneumonia, Ventilator-Associated / prevention & control*
  • Probability
  • Prospective Studies
  • Reference Values
  • Respiration, Artificial / adverse effects
  • Respiration, Artificial / methods
  • Risk Assessment
  • Sex Distribution
  • Single-Blind Method
  • Statistics, Nonparametric
  • Survival Rate
  • Toothbrushing / methods*
  • Toothbrushing / statistics & numerical data


  • Anti-Infective Agents, Local
  • chlorhexidine gluconate
  • Chlorhexidine

Associated data

  • ClinicalTrials.gov/NCT00842478