What do systematic reviews say?

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

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  Adverse effects: information from two studies, which stated that there were none; very low certainty. There is a lack of evidence about adverse effects.
  2 studies
  Very low

Air cleaning system (ACS) vs No air cleaning system

It is very uncertain whether air cleaning system (ACS) changes reduction in level of contamination in aerosols (CFU) during cavity… compared with no air cleaning system (very low certainty).

• Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases 2020 · Cochrane All outcomes
  MD -66.70 [-120.15, -13.25]
  1 study · 2 participants
  Very low

Sodium bicarbonate rinse (plus toothbrushing) vs Water rinse (plus toothbrushing)

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  Adverse effects (Berry 2011, CHX versus sodium bicarbonate versus water): no adverse events were reported associated with the interventions.
  1 study
  GRADE not reported

Chlorhexidine vs Ozonated water

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  Chlorhexidine versus ozonated water (Hanifi 2017): some evidence of a benefit for ozonated water; single study, not replicated, interpret with caution.
  1 study
  GRADE not reported

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

The review found no eligible studies for this question.

• 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

Rubber dam + HVE vs Cotton roll + HVE

It is very uncertain whether rubber dam + HVE changes reduction in level of contamination in aerosols (CFU) during… compared with cotton roll + HVE (very low certainty).

• Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases 2020 · Cochrane All outcomes
  MD -251.00 [-267.95, -234.05]
  1 study · 21 participants
  Very low

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

It is very uncertain whether toothbrushing (with or without antiseptics), as part of oral hygiene… changes duration of ICU stay compared with no toothbrushing (with or without antiseptics) (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 -1.89 [-3.52, -0.27]
  3 studies · 749 participants
  Very low

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

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).

• Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases 2020 · Cochrane All outcomes
  MD -2.20 [-14.01, 9.61]
  1 study · 6 participants
  Very low

Povidone iodine rinse vs Saline rinse or placebo

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  Adverse effects (Seguin 2014): no evidence of a difference in acute respiratory distress syndrome (RR 11.00, 95% CI 0.62 to 195.61), agitation and/or hypertension (RR 0.48, 95% CI 0.12 to 1.86), epistaxis (RR 0.14, 95%…
  1 study
  GRADE not reported

Scheduled dental recall intervals (1-, 3- or 6-monthly; oral hygiene instruction with or without scale and polish) plus daily supervised toothbrushing by carers vs usual care

Scheduled dental recall intervals (1-, 3- or 6-monthly; oral hygiene… may leads to lower calculus (long term) compared with usual care (no specific treatment) (low certainty).

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

  Long term (>12 months)
  MD -2.00 [-2.64, -1.36]
  1 study · 304 participants
  Low

Electric toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush

Electric toothbrush (self, carer or carer-assisted brushing) showed no clear difference in plaque (medium term) compared with manual toothbrush (self, carer or carer-assisted brushing) (low certainty).

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

  Medium term (6 weeks to 12 months)
  SMD 0.29 [-0.07, 0.65]
  2 studies · 120 participants
  Low
• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes

  Short term (<6 weeks)
  Assorted plaque indices scale 0-5, 1-4 weeks; 247 participants (4 RCTs); Very Low. Uncertain effect on plaque short term: 2 studies (69 participants) favoured the electric toothbrush; 2 studies (178 participants)…
  4 studies · 247 participants
  Very low

Electric toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush

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

  Long term (>12 months)
  Comparison 2.8 (reported; not GRADE-rated). One NRS (Bratel 1991, 23 participants), self-efficacy at 16 months: 10/12 people with ID using the electric toothbrush reported a preference for it, finding it easier to use…
  1 study · 23 participants
  GRADE not reported

Electric toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush

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

  Short term (<6 weeks)
  Electric vs manual toothbrush. Assorted gingival indices scale 0-4, 2-4 weeks; 252 participants (4 RCTs); Low. Four studies showed no significant differences for gingival inflammation short term; data could not be…
  4 studies · 252 participants
  Low

Oral hygiene interventions (mechanical plaque removal): knowledge-based, behavioural, or skills training for people with ID or their carers vs Usual care, no care, or a similar alternative intervention

The review found no eligible studies for this question.

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes
  No studies measured dental caries levels. One RCT (Shaw 1991, Comparison 5) assessed DMFT at baseline only and did not report caries at any later time point.
  0 studies
  No studies found

Toothpaste with a plaque-disclosing agent vs Conventional toothpaste

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

  Short term (<6 weeks)
  Toothpaste with a plaque-disclosing agent vs conventional toothpaste, children with Down syndrome. Ainamo & Bay Gingival Bleeding Index, mean 10 days; percent mean difference 18 (intervention) vs 8 (control), P<0.001…
  1 study · 40 participants
  Very low

Scheduled dental recall intervals (1-, 3- or 6-monthly; oral hygiene instruction with or without scale and polish) plus daily supervised toothbrushing by carers vs usual care

Scheduled dental recall intervals (1-, 3- or 6-monthly; oral hygiene… may leads to lower gingival pocketing (long term) compared with usual care (no specific treatment) (low certainty).

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

  Long term (>12 months)
  MD -0.60 [-0.97, -0.23]
  1 study · 304 participants
  Low

Scheduled dental recall intervals (1-, 3- or 6-monthly; oral hygiene instruction with or without scale and polish) plus daily supervised toothbrushing by carers vs usual care

Scheduled dental recall intervals (1-, 3- or 6-monthly; oral hygiene… may leads to lower plaque (long term) compared with usual care (no specific treatment) (low certainty).

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

  Long term (>12 months)
  MD -0.70 [-1.28, -0.12]
  1 study · 304 participants
  Low

Toothpaste with a plaque-disclosing agent vs Conventional toothpaste

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

  Short term (<6 weeks)
  Simplified Green & Vermillion Oral Hygiene Index (plaque), mean 10 days; percent mean difference 65 (intervention) vs 15 (control), P<0.0001 favouring the disclosing-agent toothpaste; 40 participants (SoF states 80,…
  1 study · 40 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 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 interventions (mechanical plaque removal): knowledge-based, behavioural, or skills training for people with ID or their carers vs Usual care, no care, or a similar alternative intervention

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes
  Adverse/unintended effects addressed narratively: 10 of 34 studies investigated or reported negative unintended or adverse effects (e.g. difficulty with the electric or 3-headed toothbrushes, being frightened by the…
  10 studies
  GRADE not reported