The link between oral bacteria and respiratory infections is well documented. Dental plaque has the potential to be colonized by respiratory pathogens and this, together with microaspiration of oral bacteria, can lead to pneumonia particularly in the elderly and critically ill. The provision of adequate oral care is therefore essential for the maintenance of good oral health and the prevention of respiratory complications. Numerous oral care practices are utilised for intubated patients, with a clear lack of consensus on the best approach for oral care. This narrative review aims to explore the oral-lung connection and discuss in detail current oral care practices to identify shortcomings and offer suggestions for future research. The importance of adequate oral care has been recognised in guideline interventions for the prevention of pneumonia, but practices differ and controversy exists particularly regarding the use of chlorhexidine. The oral health assessment is also an important but often overlooked element of oral care that needs to be considered. Oral care plans should ideally be implemented on the basis of an individual oral health assessment. An oral health assessment prior to provision of oral care should identify patient needs and facilitate targeted oral care interventions. Oral health is an important consideration in the management of the critically ill. Studies have suggested benefit in the reduction of respiratory complication such as Ventilator Associated Pneumonia associated with effective oral health care practices. However, at present there is no consensus as to the best way of providing optimal oral health care in the critically ill. Further research is needed to standardise oral health assessment and care practices to enable development of evidenced based personalised oral care for the critically ill.

中文翻译：

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危重病人的口腔保健：叙述性评论

口腔细菌和呼吸道感染之间的联系是有据可查的。牙菌斑有可能被呼吸道病原体定植，这与口腔细菌的微吸入一起可能导致肺炎，特别是在老年人和危重病人中。因此，提供足够的口腔护理对于维持良好的口腔健康和预防呼吸系统并发症至关重要。许多口腔护理实践用于插管患者，但对于口腔护理的最佳方法显然缺乏共识。这篇叙述性综述旨在探索口肺之间的联系，并详细讨论当前的口腔护理实践，以找出缺点并为未来的研究提供建议。预防肺炎的指南干预措施已经认识到充分口腔护理的重要性，但做法不同，尤其是在使用氯己定方面存在争议。口腔健康评估也是口腔护理中需要考虑的一个重要但经常被忽视的要素。理想情况下，口腔护理计划应在个人口腔健康评估的基础上实施。在提供口腔护理之前进行口腔健康评估应确定患者的需求并促进有针对性的口腔护理干预。口腔健康是危重病人管理的重要考虑因素。研究表明，与有效的口腔保健实践相关的呼吸系统并发症（例如呼吸机相关肺炎）的减少有益。然而，目前对于为危重患者提供最佳口腔保健的最佳方式尚未达成共识。