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We are uncertain as to the effects of toothbrushing (± antiseptics) on the outcomes of VAP ( RR , 95% CI to , P = , I 2 = 64%, five RCTs , 889 participants, very low quality evidence) and mortality ( RR , 95% CI to , P = , I 2 = 0%, five RCTs , 889 participants, low quality evidence) compared to OHC without toothbrushing (± antiseptics). There is insufficient evidence to determine whether toothbrushing affects duration of mechanical ventilation , duration of ICU stay, use of systemic antibiotics, oral health indices, adverse effects , caregivers' preferences or cost.
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