Prospective longitudinal observational studies of hospitalised individuals of any age were eligible for inclusion. Studies were required to report changes in tooth loss, periodontal health, dental caries and/or stomatological diseases. Studies of patients with psychiatric disorders or receiving treatment with frequently observed oral complications were excluded.
Participants in most of the studies were adults with a mean age of 49 to 58 years. One study included children (age range one to 16 years). All or most participants were patients on intensive care units in USA or Europe and most were intubated. Where reported, interventions included: toothpaste, sterile water, normal saline and/or lip lubricant delivered using a child's toothbrush, foam swabs or sterile cloths; and/or antiseptics and antifungals (at the nurses' discretion). Oral care was given from 2-6 times daily (where reported). Most studies did not report adherence rates. Where reported, the mean or median duration of observation across study subgroups ranged from five to 20 days. A wide variety of outcomes were assessed, most commonly dental plaque and/or gingival inflammation. Other reported outcomes included caries, mucositis, dental health and periodontal disease. These were measured with a variety of tools such as subjective visual analogue scales,the oral assessment guide, the Community Periodontal Index for Treatment Needs and the decayed, missed and filled teeth index. In most cases it was unclear who conducted the assessment and whether they were blinded.
One reviewer conducted the initial stages of the search and two reviewers screened all full-text articles. Disagreements were resolved with the help of a third reviewer.