{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T11:39:33Z","timestamp":1793360373482,"version":"4.5.0"},"reference-count":71,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:sec id=\"ab-ioi230082-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Hospital-acquired pneumonia (HAP) is the most common and morbid health care\u2013associated infection, but limited data on effective prevention strategies are available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230082-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether daily toothbrushing is associated with lower rates of HAP and other patient-relevant outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230082-6\">\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>A search of PubMed, Embase, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and 3 trial registries was performed from inception through March 9, 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230082-7\">\n                    <jats:title>Study Selection<\/jats:title>\n                    <jats:p>Randomized clinical trials of hospitalized adults comparing daily oral care with toothbrushing vs regimens without toothbrushing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230082-8\">\n                    <jats:title>Data Extraction and Synthesis<\/jats:title>\n                    <jats:p>Data extraction and risk of bias assessments were performed in duplicate. Meta-analysis was performed using random-effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230082-9\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The primary outcome of this systematic review and meta-analysis was HAP. Secondary outcomes included hospital and intensive care unit (ICU) mortality, duration of mechanical ventilation, ICU and hospital lengths of stay, and use of antibiotics. Subgroups included patients who received invasive mechanical ventilation vs those who did not, toothbrushing twice daily vs more frequently, toothbrushing provided by dental professionals vs general nursing staff, electric vs manual toothbrushing, and studies at low vs high risk of bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230082-10\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 15 trials met inclusion criteria, including 10\u202f742 patients (2033 in the ICU and 8709 in non-ICU departments; effective population size was 2786 after shrinking the population to account for 1 cluster randomized trial in non-ICU patients). Toothbrushing was associated with significantly lower risk for HAP (risk ratio [RR], 0.67 [95% CI, 0.56-0.81]) and ICU mortality (RR, 0.81 [95% CI, 0.69-0.95]). Reduction in pneumonia incidence was significant for patients receiving invasive mechanical ventilation (RR, 0.68 [95% CI, 0.57-0.82) but not for patients who were not receiving invasive mechanical ventilation (RR, 0.32 [95% CI, 0.05-2.02]). Toothbrushing for patients in the ICU was associated with fewer days of mechanical ventilation (mean difference, \u22121.24 [95% CI, \u22122.42 to \u22120.06] days) and a shorter ICU length of stay (mean difference, \u22121.78 [95% CI, \u22122.85 to \u22120.70] days). Brushing twice a day vs more frequent intervals was associated with similar effect estimates. Results were consistent in a sensitivity analysis restricted to 7 studies at low risk of bias (1367 patients). Non-ICU hospital length of stay and use of antibiotics were not associated with toothbrushing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi230082-11\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings of this systematic review and meta-analysis suggest that daily toothbrushing may be associated with significantly lower rates of HAP, particularly in patients receiving mechanical ventilation, lower rates of ICU mortality, shorter duration of mechanical ventilation, and shorter ICU length of stay. Policies and programs encouraging more widespread and consistent toothbrushing are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamainternmed.2023.6638","type":"journal-article","created":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T11:01:03Z","timestamp":1702897263000},"page":"131","source":"Crossref","is-referenced-by-count":83,"title":["Association Between Daily Toothbrushing and Hospital-Acquired Pneumonia"],"prefix":"10.1001","volume":"184","author":[{"given":"Selina","family":"Ehrenzeller","sequence":"first","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts"},{"name":"Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, 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