• Cindy L Munro, Mary Jo Grap, R K Elswick, Jessica McKinney, Curtis N Sessler, and Russell S Hummel.
• Adult Health Department, School of Nursing, Virginia Commonwealth University, Richmond, VA 23298-0567, USA. cmunro@vcu.edu
• Am. J. Crit. Care. 2006 Sep 1;15(5):453-60.

BackgroundVentilator-associated pneumonia is a significant cause of morbidity and mortality and may be influenced by oral health.ObjectiveTo describe the relationship between ventilator-associated pneumonia and oral health status, changes in oral health status during the first 7 days after intubation, and microbial colonization of the oropharynx and trachea.MethodsA total of 66 patients were enrolled within 24 hours of intubation and were followed up for up to 7 days. Data on oral health measures and the Clinical Pulmonary Infection Score (CPIS) were collected at baseline, day 4 (n = 37), and day 7 (n = 21). A regression model was used to predict risk of pneumonia at day 4.ResultsDental plaque and oral organisms increased over time. Correlations were significant for baseline and day 4 dental plaque (P < .001), baseline salivary lactoferrin and day 4 plaque (P = .01), and lower salivary volume and higher day 4 CPIS (P = .02). Potential pathogens were identified in oral cultures for 6 patients before or at the same time as the appearance of the organisms in tracheal aspirates. Correlations were significant with day 4 CPIS for score on the Acute Physiology and Chronic Health Evaluation (APACHE) II (P = .007), day 4 salivary volume (P = .02), interaction of APACHE II score and day 1 CPIS (P<.001), and interaction of day 1 CPIS and plaque (P=.01).ConclusionsHigher dental plaque scores confer greater risk for ventilator-associated pneumonia, particularly for patients with greater severity of illness. Salivary volume and lactoferrin may affect the risk.

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