What do systematic reviews say?

Povidone iodine rinse vs usual or supportive care

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  Povidone iodine versus usual care (Seguin 2006, 67 participants): a reduction in VAP was found; single study, not replicated, interpret with caution.
  1 study · 67 participants
  GRADE not reported

Clinical examination with 24-month recall vs Clinical examination with 6-month recall

Clinical examination with 24-month recall showed no clear difference in patient satisfaction with actual care received (1-7 scale) compared with clinical examination with 6-month recall; GRADE not reported.

• Recall intervals for oral health in primary care patients 2020 · Cochrane All outcomes

  4 years
  MD -0.11 [-0.26, 0.04]
  1 study · 308 participants
  GRADE not reported

Saline rinse vs Saline-soaked swab

Saline rinse led to lower duration of mechanical ventilation compared with saline-soaked swab; GRADE not reported.

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  MD -6.83 [-8.94, -4.72]
  2 studies · 176 participants
  GRADE not reported

Saline rinse plus swab vs Saline-soaked swab

Saline rinse plus swab led to lower incidence of VAP compared with saline-soaked swab alone (usual care); GRADE not reported.

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  RR 0.41 [0.23, 0.72]
  2 studies · 153 participants
  GRADE not reported

Intraglandular botulinum neurotoxin (BoNT) injection vs No BoNT (placebo or pre-treatment baseline)

Salivary Lactobacilli counts were unchanged in two studies but significantly increased in one study one month after BoNT (ungraded; no effect estimate reported).

• Oral health effects of botulinum toxin treatment for drooling: a systematic review. 2020 All outcomes

  Before vs after BoNT injection (2018 study: significant Lactobacilli increase at 1 month; Wu 2011 and 2017 study no change) · Neurological-disease populations with drooling (e.g., cerebral palsy, Parkinson disease, adults with sialorrhea); specialist clinical care
  No statistically significant changes in Lactobacilli CFU counts were reported by Wu et al. or by Tiigimae-Saar 2017. However, the 2018 study found that Lactobacilli CFU counts were significantly increased one month…
  3 studies
  GRADE not reported

Clinical examination with risk-based recall vs Clinical examination with 24-month recall

Clinical examination with risk-based recall showed no clear difference in cost (healthcare-system perspective): total cost per patient (GBP) compared with clinical examination with 24-month recall; GRADE not reported.

• Recall intervals for oral health in primary care patients 2020 · Cochrane All outcomes

  4 years
  MD 17.00 [-14.34, 48.34]
  1 study · 404 participants
  GRADE not reported

Clinical examination with risk-based recall vs Clinical examination with 24-month recall

Clinical examination with risk-based recall showed no clear difference in periodontal disease: gingival bleeding (percentage of sites) compared with clinical examination with 24-month recall (high certainty).

• Recall intervals for oral health in primary care patients 2020 · Cochrane All outcomes

  4 years
  MD -0.07 [-4.10, 3.96]
  1 study · 279 participants
  High

Chlorhexidine vs Nanosil (nanosilver)

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  Chlorhexidine versus Nanosil (Khaky 2018): some evidence of a benefit for Nanosil; single study, not replicated, interpret with caution.
  1 study
  GRADE not reported

Triclosan rinse vs Saline rinse

Triclosan rinse led to lower duration of ICU stay compared with saline rinse; GRADE not reported.

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  MD -4.97 [-5.55, -4.39]
  1 study · 324 participants
  GRADE not reported

Hydrogen peroxide vs Normal saline

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  Hydrogen peroxide versus normal saline (Nobahar 2016): a reduction in VAP was found; single study, not replicated, interpret with caution.
  1 study
  GRADE not reported

Potassium permanganate vs placebo

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  Potassium permanganate versus placebo (Meidani 2018, 100 participants): no evidence of a difference in mortality; single study.
  1 study · 100 participants
  GRADE not reported

Intraglandular botulinum neurotoxin (BoNT) injection vs No BoNT (placebo or pre-treatment baseline)

No included study reported salivary osmolality; this pre-planned outcome remains unassessed (no studies).

• Oral health effects of botulinum toxin treatment for drooling: a systematic review. 2020 All outcomes

  Neurological-disease populations with drooling (e.g., cerebral palsy, Parkinson disease, adults with sialorrhea); specialist clinical care
  no estimate extracted
  0 studies
  No studies found

Chlorhexidine vs Potassium permanganate

Chlorhexidine showed no clear difference in incidence of VAP compared with potassium permanganate; GRADE not reported.

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  RR 0.87 [0.50, 1.52]
  2 studies
  GRADE not reported

Essential oil mouthwash vs Sodium bicarbonate rinse

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  Listerine versus sodium bicarbonate (Berry 2013): no evidence of a difference in VAP incidence; single study, high risk of bias.
  1 study
  GRADE not reported

Clinical examination with risk-based recall vs Clinical examination with 6-month recall

Clinical examination with risk-based recall showed no clear difference in patient satisfaction with actual care received (1-7 scale) compared with clinical examination with 6-month recall; GRADE not reported.

• Recall intervals for oral health in primary care patients 2020 · Cochrane All outcomes

  4 years
  MD 0.03 [-0.03, 0.09]
  1 study · 1607 participants
  GRADE not reported

Intraglandular botulinum neurotoxin (BoNT) injection vs No BoNT (placebo or pre-treatment baseline)

BoNT injections were not associated with significant changes in salivary S. mutans counts across three studies (ungraded; no effect estimate reported).

• Oral health effects of botulinum toxin treatment for drooling: a systematic review. 2020 All outcomes

  Before vs after BoNT injection · Neurological-disease populations with drooling (e.g., cerebral palsy, Parkinson disease, adults with sialorrhea); specialist clinical care
  The RCT by Wu et al. reported no statistically significant changes in S. mutans CFU counts (p-values only). The studies of Tiigimae-Saar did not find statistically significant differences in S. mutans CFU counts either.
  3 studies
  GRADE not reported

Saline rinse vs Saline-soaked swab

Saline rinse led to lower incidence of VAP compared with saline-soaked swab; GRADE not reported.

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  RR 0.47 [0.37, 0.62]
  4 studies · 488 participants
  GRADE not reported

Clinical examination with 24-month recall vs Clinical examination with 12-month recall

Clinical examination with 24-month recall showed no clear difference in total time (examination plus treatment) (minutes) compared with clinical examination with 12-month recall; GRADE not reported.

• Recall intervals for oral health in primary care patients 2020 · Cochrane All outcomes

  2 years · 3-5 year olds (primary teeth)
  MD -10 [-26.7, 6.7]
  1 study · 58 participants
  GRADE not reported
• Recall intervals for oral health in primary care patients 2020 · Cochrane All outcomes

  2 years · 16-20 year olds (permanent teeth)
  MD -23.7 [-43.28, -4.12]
  1 study · 127 participants
  GRADE not reported

Povidone iodine rinse vs Saline rinse or placebo

Povidone iodine rinse showed no clear difference in mortality compared with saline rinse or placebo; GRADE not reported.

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  RR 1.00 [0.66, 1.50]
  2 studies · 217 participants
  GRADE not reported

Clinical examination with risk-based recall vs Clinical examination with 6-month recall

Clinical examination with risk-based recall showed no clear difference in periodontal disease: gingival bleeding (percentage of sites) compared with clinical examination with 6-month recall (high certainty).

• Recall intervals for oral health in primary care patients 2020 · Cochrane All outcomes

  4 years
  MD 0.78 [-1.17, 2.73]
  1 study · 1472 participants
  High