Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland.
Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, The Wellcome-Wolfson Building, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK.
Crit Care. 2021 Oct 1;25(1):353. doi: 10.1186/s13054-021-03765-5.
The link between oral bacteria and respiratory infections is well documented. Dental plaque has the potential to be colonized by respiratory pathogens and this, together with microaspiration of oral bacteria, can lead to pneumonia particularly in the elderly and critically ill. The provision of adequate oral care is therefore essential for the maintenance of good oral health and the prevention of respiratory complications.
Numerous oral care practices are utilised for intubated patients, with a clear lack of consensus on the best approach for oral care. This narrative review aims to explore the oral-lung connection and discuss in detail current oral care practices to identify shortcomings and offer suggestions for future research. The importance of adequate oral care has been recognised in guideline interventions for the prevention of pneumonia, but practices differ and controversy exists particularly regarding the use of chlorhexidine. The oral health assessment is also an important but often overlooked element of oral care that needs to be considered. Oral care plans should ideally be implemented on the basis of an individual oral health assessment. An oral health assessment prior to provision of oral care should identify patient needs and facilitate targeted oral care interventions.
Oral health is an important consideration in the management of the critically ill. Studies have suggested benefit in the reduction of respiratory complication such as Ventilator Associated Pneumonia associated with effective oral health care practices. However, at present there is no consensus as to the best way of providing optimal oral health care in the critically ill. Further research is needed to standardise oral health assessment and care practices to enable development of evidenced based personalised oral care for the critically ill.
口腔细菌与呼吸道感染之间的联系已有充分的文献记载。牙菌斑有可能被呼吸道病原体定植，再加上口腔细菌的微吸入，可能导致肺炎，尤其是在老年人和重症患者中。因此，提供充分的口腔护理对于维护良好的口腔健康和预防呼吸道并发症至关重要。
对于插管患者，有许多口腔护理措施被采用，但对于最佳口腔护理方法却缺乏共识。本综述旨在探讨口腔-肺部的联系，并详细讨论当前的口腔护理措施，以发现不足之处并为未来的研究提供建议。充分的口腔护理的重要性在预防肺炎的指南干预中得到了认可，但实践存在差异，特别是关于氯己定的使用存在争议。口腔健康评估也是口腔护理的一个重要但经常被忽视的要素，需要加以考虑。口腔护理计划最好应根据个体的口腔健康评估来实施。在提供口腔护理之前进行口腔健康评估，应能识别患者的需求并促进有针对性的口腔护理干预。
口腔健康是危重症患者管理中的一个重要考虑因素。研究表明，有效的口腔卫生保健措施可降低与呼吸机相关肺炎相关的呼吸道并发症的发生。然而，目前对于如何为危重症患者提供最佳口腔卫生护理，尚无共识。需要进一步的研究来标准化口腔健康评估和护理实践，以便为危重症患者制定基于证据的个性化口腔护理。
