What do systematic reviews say?

250 questions · 288 findings · 13 reviews · Dental public health and special care

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No studies found 73 · 25.3%GRADE not reported 90 · 31.3%Very low 90 · 31.3%Low 29 · 10.1%Moderate 6 · 2.1%High 0 · 0%

Toothbrushing (with or without antiseptics), as part of oral hygiene care vs No toothbrushing (with or without antiseptics)

All‐cause mortality · Critically ill adults receiving mechanical ventilation in ICU

Toothbrushing (with or without antiseptics), as part of oral hygiene… showed no clear difference in mortality compared with no toothbrushing (with or without antiseptics) (low certainty).

1 finding from 1 review

Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
Follow-up: mean 1 month
RR 0.84 [0.67, 1.05]
5 studies · 910 participants
Low

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

Adverse effects · Critically ill patients (adults and children) receiving mechanical ventilation in ICU

1 finding from 1 review

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

Saline rinse vs Saline-soaked swab

Incidence of VAP · Critically ill patients receiving mechanical ventilation in ICU

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

1 finding from 1 review

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

Toothbrushing (with or without antiseptics), as part of oral hygiene care vs No toothbrushing (with or without antiseptics)

Systemic antibiotic use · Critically ill adults receiving mechanical ventilation in ICU

The review found no eligible studies for this question.

1 finding from 1 review

Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
This outcome was not reported by any of the studies in this comparison.
0 studies
No studies found

Povidone iodine coolant vs Distilled water coolant

Reduction in level of contamination in aerosols (CFU): cinnamon extract coolant vs distilled water during ultrasonic scaling · People undergoing aerosol-generating procedures (AGPs) in a dental setting

It is very uncertain whether povidone iodine coolant changes reduction in level of contamination in aerosols (CFU): povidone… compared with distilled water coolant (very low certainty).

1 finding from 1 review

Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases 2020 · Cochrane All outcomes
MD -656.45 [-672.74, -640.16]
1 study · 40 participants
Very low

Povidone iodine rinse vs Saline rinse or placebo

All‐cause mortality · Critically ill patients receiving mechanical ventilation in ICU

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

1 finding from 1 review

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

Triclosan rinse vs Saline rinse

Duration of mechanical ventilation · Critically ill patients receiving mechanical ventilation in ICU

Triclosan rinse led to lower duration of mechanical ventilation compared with saline rinse; GRADE not reported.

1 finding from 1 review

Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
MD -5.24 [-5.64, -4.84]
1 study · 324 participants
GRADE not reported

Toothbrushing (with or without antiseptics), as part of oral hygiene care vs No toothbrushing (with or without antiseptics)

Caregivers' preferences for oral hygiene care · Critically ill adults receiving mechanical ventilation in ICU

The review found no eligible studies for this question.

1 finding from 1 review

Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
The outcome of caregivers' preferences was not reported by any study in this comparison.
0 studies
No studies found

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

All‐cause mortality · Critically ill patients (adults and children) receiving mechanical ventilation in ICU

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

1 finding from 1 review

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

Antimicrobial mouthwash and/or nasal spray (alone or in combination), any concentration, frequency or dosage vs No treatment or saline or water

COVID-19 viral content of aerosol (when present) · Patients with suspected or confirmed COVID-19 infection

The review found no eligible studies for this question.

1 finding from 1 review

Antimicrobial mouthwashes (gargling) and nasal sprays administered to patients with suspected or confirmed COVID‐19… 2020 · Cochrane All outcomes
No data available (no included studies)
0 studies
No studies found

Ozonisation vs No ozonisation / standard operatory

Outcome not reported · Dental healthcare providers (dentist, dental surgery assistant, dental hygienist, dental technologist, dental laboratory staff, dental…

The review found no eligible studies for this question.

1 finding from 1 review

Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases 2020 · Cochrane All outcomes
no estimate extracted
0 studies
No studies found

High-volume evacuation (HVE) vs Conventional dental suction (low-volume evacuator / saliva ejector)

Reduction in level of contamination in aerosols (CFU) during ultrasonic scaling at 40 cm from mouth · People undergoing aerosol-generating procedures (AGPs) in a dental setting

It is very uncertain whether high-volume evacuation (HVE) changes reduction in level of contamination in aerosols (CFU) during… compared with conventional dental suction (low-volume evacuator / saliva ejector) (very low certainty).

1 finding from 1 review

Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases 2020 · Cochrane All outcomes
MD -2.30 [-5.32, 0.72]
1 study · 6 participants
Very low

Toothbrushing (with or without antiseptics), as part of oral hygiene care vs No toothbrushing (with or without antiseptics)

Incidence of VAP · Critically ill adults receiving mechanical ventilation in ICU

Toothbrushing (with or without antiseptics), as part of oral hygiene… may leads to lower incidence of VAP compared with no toothbrushing (with or without antiseptics) (low certainty).

1 finding from 1 review

Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
Follow-up: mean 1 month
RR 0.61 [0.41, 0.91]
5 studies · 910 participants
Low

Any antimicrobial mouthwash and/or nasal spray (alone or in combination), at any concentration, delivered to the patient or HCW before and/or after an AGP vs No treatment or saline or water

Change in COVID-19 viral load at site(s) of irrigation · Patients without suspected or confirmed COVID-19 infection undergoing aerosol-generating procedures (AGPs), and the healthcare workers…

The review found no eligible studies for this question.

1 finding from 1 review

Antimicrobial mouthwashes (gargling) and nasal sprays to protect healthcare workers when undertaking… 2020 · Cochrane All outcomes
No data available (no included studies)
Studies not reported
No studies found

Any antimicrobial mouthwash and/or nasal spray (alone or in combination), at any concentration, delivered to the patient or HCW before and/or after an AGP vs No treatment or saline or water

Anosmia (or disturbance in sense of smell) · Patients without suspected or confirmed COVID-19 infection undergoing aerosol-generating procedures (AGPs), and the healthcare workers…

The review found no eligible studies for this question.

1 finding from 1 review

Antimicrobial mouthwashes (gargling) and nasal sprays to protect healthcare workers when undertaking… 2020 · Cochrane All outcomes
Assessed at a minimum of 2 weeks
No data available (no included studies)
Studies not reported
No studies found

Chlorhexidine vs Potassium permanganate

All‐cause mortality · Critically ill patients receiving mechanical ventilation in ICU

Chlorhexidine showed no clear difference in mortality compared with potassium permanganate; GRADE not reported.

1 finding from 1 review

Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
RR 1.11 [0.89, 1.38]
2 studies
GRADE not reported

Saline rinse vs usual or supportive care

Duration of ICU stay · Critically ill patients receiving mechanical ventilation in ICU

Saline rinse showed no clear difference in duration of ICU stay compared with usual care (no rinse); GRADE not reported.

1 finding from 1 review

Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
MD -1.17 [-3.95, 1.60]
2 studies · 324 participants
GRADE not reported

Ultraviolet (UV) light air decontamination vs No UV light / standard operatory

Outcome not reported · Dental healthcare providers (dentist, dental surgery assistant, dental hygienist, dental technologist, dental laboratory staff, dental…

The review found no eligible studies for this question.

1 finding from 1 review

Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases 2020 · Cochrane All outcomes
no estimate extracted
0 studies
No studies found

Essential oil mouthwash vs Sterile water rinse

Incidence of VAP · Critically ill patients receiving mechanical ventilation in ICU

1 finding from 1 review

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

Saline rinse vs Saline-soaked swab

All‐cause mortality · Critically ill patients receiving mechanical ventilation in ICU

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

1 finding from 1 review

Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
RR 0.29 [0.12, 0.69]
2 studies · 270 participants
GRADE not reported