What do systematic reviews say?

Oral hygiene training (toothbrushing routine) of people with ID vs No oral hygiene training of people with ID

It is very uncertain whether oral hygiene training (toothbrushing routine) of people with ID changes plaque (short term) compared with no oral hygiene training of people with ID (very low certainty).

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Short term (<6 weeks)
  MD -0.47 [-0.92, -0.02]
  1 study · 10 participants
  Very low

Oral hygiene training (toothbrushing routine) of people with ID vs No oral hygiene training of people with ID

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Long term (>12 months)
  Behaviour, attitude and self-efficacy (steps achieved in a toothbrushing routine), 100 days to 19 months; 59 participants (4 NRS); Very Low. Results not in a format for meta-analysis: 3 NRS (56 participants) reported…
  4 studies · 59 participants
  Very low

Oral hygiene training (toothbrushing routine) of people with ID vs No oral hygiene training of people with ID

It is very uncertain whether oral hygiene training (toothbrushing routine) of people with ID changes gingival inflammation (short term) compared with no oral hygiene training of people with ID (very low certainty).

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Short term (<6 weeks)
  MD -0.28 [-0.90, 0.34]
  1 study · 10 participants
  Very low

Individualised oral care plan based on a multidisciplinary assessment vs usual care

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Medium term (6 weeks to 12 months)
  Individualised oral care plan vs usual care. Subjective Oral Hygiene Rating scale 1-5 and Improvement Differential, mean 12 months; SOHR 2.97 (intervention) vs 3.10 (control); improvement differential 38% vs 5%; 79…
  1 study · 79 participants
  Very low

Discussion of individual clinical photographs (plaque highlighted by a disclosing agent) as an oral hygiene motivator, plus oral hygiene instruction vs No discussion of clinical photographs, but received the same oral hygiene instruction

It is very uncertain whether discussion of individual clinical photographs (plaque highlighted by… changes plaque (medium term) compared with no discussion of clinical photographs, but received the same oral… (very low certainty).

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Medium term (6 weeks to 12 months)
  MD -0.10 [-0.85, 0.65]
  1 study · 29 participants
  Very low

Biotene OralBalance vs control

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  Biotene OralBalance versus control (Stefanescu 2013, 41 participants): no difference in incidence of VAP; single study, high risk of bias.
  1 study · 41 participants
  GRADE not reported

Biotene OralBalance vs control

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  Adverse effects (Stefanescu 2013): no significant difference between groups with respect to adverse events in buccal mucosa.
  1 study
  GRADE not reported

Oral hygiene care training of carers vs No training (or a placebo training session) of carers

Oral hygiene care training of carers showed no clear difference in plaque (medium term) compared with no training (or a placebo training session) of carers (low certainty).

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Medium term (6 weeks to 12 months)
  MD -0.07 [-0.26, 0.13]
  2 studies · 99 participants
  Low

Oral hygiene care training of carers vs No training (or a placebo training session) of carers

It is very uncertain whether oral hygiene care training of carers changes behaviour, attitude and self-efficacy of carers (medium term) compared with no training (or a placebo training session) of carers (very low certainty).

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Medium term (6 weeks to 12 months)
  MD 0.15 [-0.80, 1.10]
  2 studies · 189 participants
  Very low

Oral hygiene care training of carers vs No training (or a placebo training session) of carers

Oral hygiene care training of carers showed no clear difference in gingival inflammation (medium term) compared with no training (or a placebo training session) of carers (low certainty).

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Medium term (6 weeks to 12 months)
  MD -0.09 [-0.63, 0.45]
  2 studies · 99 participants
  Low

Any form of one-to-one oral hygiene advice (OHA) vs No OHA

• One‐to‐one oral hygiene advice provided in a dental setting for oral health 2018 · Cochrane All outcomes
  Hetland 1982 reported pocket depths > 4 mm; measured but not synthesised or GRADE-rated (no usable pooled estimate).
  1 study
  GRADE not reported

Any form of one-to-one oral hygiene advice (OHA) vs No OHA

It is very uncertain whether any form of one-to-one oral hygiene advice (OHA) changes dental caries compared with no OHA (very low certainty).

• One‐to‐one oral hygiene advice provided in a dental setting for oral health 2018 · Cochrane All outcomes

  4 to 12 months
  SoF: 1 study in adults reported only 'small and statistically insignificant changes' but no usable data; the other study on infants provided evidence of a benefit for OHA at 8 and 12 months but not at 4 months.…
  2 studies · 244 participants
  Very low

Any form of one-to-one oral hygiene advice (OHA) vs No OHA

It is very uncertain whether any form of one-to-one oral hygiene advice (OHA) changes periodontal health: gingivitis compared with no OHA (very low certainty).

• One‐to‐one oral hygiene advice provided in a dental setting for oral health 2018 · Cochrane All outcomes

  3 to 36 months
  SoF: 1 small study in adults had contradictory results at 3 and 6 months; the other study in adults showed evidence of a benefit for OHA at all time points (12, 24, 36 months). Results: Hetland 1982 MD 0.25 (0.05 to…
  2 studies · 235 participants
  Very low

Any form of one-to-one oral hygiene advice (OHA) vs No OHA

• One‐to‐one oral hygiene advice provided in a dental setting for oral health 2018 · Cochrane All outcomes
  Hoogstraten 1983 (dental knowledge, attitude, behaviour, fear of dental treatment) and Memarpour 2016 (parents' knowledge and performance regarding oral health); measured, not synthesised or GRADE-rated.
  2 studies
  GRADE not reported

Any form of one-to-one oral hygiene advice (OHA) vs No OHA

• One‐to‐one oral hygiene advice provided in a dental setting for oral health 2018 · Cochrane All outcomes
  No adverse events due to OHA were reported in the included trials (review-wide; assessed across all 19 included studies).
  Studies not reported
  GRADE not reported

Any form of one-to-one oral hygiene advice (OHA) vs No OHA

Any form of one-to-one oral hygiene advice (OHA) showed no clear difference in periodontal health: plaque levels compared with no OHA (low certainty).

• One‐to‐one oral hygiene advice provided in a dental setting for oral health 2018 · Cochrane All outcomes

  6 to 36 months
  SoF: Both studies at all time points consistently showed a benefit in plaque reduction for OHA. Results: Hetland 1982 MD -0.41 (-0.54 to -0.28) at 3mo, -0.44 (-0.56 to -0.32) at 6mo; Hugoson 2007 MD -13.00 (-19.89 to…
  2 studies · 235 participants
  Low

Chlorhexidine (mouthrinse or gel), as part of oral hygiene care vs placebo or usual care

Chlorhexidine (mouthrinse or gel), as part of oral hygiene care probably leads to lower incidence of VAP compared with placebo or usual care (moderate certainty).

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes

  Follow-up: mean 1 month
  RR 0.67 [0.47, 0.97]
  13 studies · 1206 participants
  Moderate

Chlorhexidine (mouthrinse or gel), as part of oral hygiene care vs placebo or usual care

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  Adverse effects: information from 2 studies; one stated there were none, the other reported mild reversible irritation of the oral mucosa; very low certainty. There was a lack of evidence about adverse effects.
  2 studies
  Very low

Chlorhexidine (mouthrinse or gel), as part of oral hygiene care vs placebo or usual care

Chlorhexidine (mouthrinse or gel), as part of oral hygiene care showed no clear difference in mortality compared with placebo or usual care (moderate certainty).

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes

  Follow-up: mean 1 month
  RR 1.03 [0.80, 1.33]
  9 studies · 944 participants
  Moderate

Chlorhexidine (mouthrinse or gel), as part of oral hygiene care vs placebo or usual care

It is very uncertain whether chlorhexidine (mouthrinse or gel), as part of oral hygiene care changes duration of mechanical ventilation compared with placebo or usual care (very low certainty).

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes

  Follow-up: mean 1 month
  MD -1.10 [-3.20, 1.00]
  4 studies · 594 participants
  Very low