Risk-Adapted Oral Care Protocols for Critically Ill Patients: Scientific Rationale And Clinical Perspectives

Abstract

Oral deterioration in critical illness is heterogeneous. A cooperative non-intubated patient with preserved salivary flow does not require the same intensity or technique of care as an intubated patient with severe xerostomia, mucosal ulceration, bleeding risk and impaired swallowing. Uniform schedules may therefore result in under-treatment of high-risk patients and unnecessary or unsafe procedures in others. This narrative review develops the scientific rationale for a risk-adapted oral care framework based on systemic stability, airway status, aspiration risk, mucosal integrity, salivary function, dental and prosthetic conditions, and capacity for self-care. The proposed framework links assessment findings to mechanical plaque control, moisturizing care, device-pressure prevention, secretion management, antiseptic use when indicated, documentation and referral. It is presented as a conceptual protocol requiring local adaptation and prospective validation, not as an already proven intervention.