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Effects of a Standard Versus Comprehensive Oral Care Protocol Among Intubated Neuroscience ICU Patients: Results of a Randomized Controlled Trial

Prendergast, Virginia; Jakobsson, Ulf; Renvert, Stefan; Hallberg, Ingalill Rahm

Journal of Neuroscience Nursing: June 2012 - Volume 44 - Issue 3 - p 134–146
doi: 10.1097/JNN.0b013e3182510688

ABSTRACT The purpose of the study was to compare changes in oral health during intubation until 48 hours after extubation in neuroscience intensive care unit (ICU) patients enrolled in a standard or a comprehensive oral care protocol. The effects of manual toothbrushing (standard group, n = 31) were compared with those of tongue scraping, electric toothbrushing, and moisturizing (comprehensive group, n = 25) in intubated patients in a neuroscience ICU in a 2-year randomized clinical trial. Oral health was evaluated based on the Oral Assessment Guide (OAG) on enrollment, the day of extubation, and 48 hours after extubation. There were no significant differences in the frequency of the oral care protocol. Protocol compliance exceeded 91% in both groups. The total OAG score and all eight categories significantly deteriorated (Friedman test, p < .001, Bonferroni corrected) in the standard oral care group and did not return to baseline after extubation. Large effect sizes were present at all three points in this group. The total OAG score deteriorated during intubation within the comprehensive protocol group (Friedman test, p < .004) but returned to baseline status after extubation. In four categories, the ratings on tongue, mucous membranes, gingiva, and teeth did not deteriorate significantly over time. Published oral care protocols are substandard in promoting and maintaining oral health in intubated patients. A comprehensive oral care protocol, using a tongue scraper, an electrical toothbrush, and pharmacological moisturizers, was more effective for oral hygiene throughout intubation and after extubation than manual toothbrushing alone.

Questions or comments about this article may be directed to Virginia Prendergast, PhD NP CNRN, at She is from the Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, and Department of Health Sciences, Lund University, Lund, Sweden.

Ulf Jakobsson, PhD, is docent at the Center of Primary Health Care Research, Faculty of Medicine, Lund University, Lund, Sweden.

Stefan Renvert, DDS PhD, is professor at Department of Oral Health Science, Section for Health and Society, Kristianstad University, Kristianstad, Sweden; School of Dental Science, Trinity College, Dublin, Ireland; and Blekinge Institute of Technology, Karlskrona, Sweden.

Ingalill Rahm Hallberg, RNT PhD, is professor at the Department of Health Sciences, Lund University, Lund, Sweden.

The authors received a grant from the Barrow Neurological Foundation for this study.

The authors declare no conflicts of interest.

© 2012 American Association of Neuroscience Nurses