Effect of Octenidine Dihydrochloride on Gingival Inflammation, Dental Plaque, and Xerostomia in Patients Receiving Respiratory Support

Maintaining oral hygiene in patients receiving respiratory support is critically important for preventing healthcare-associated infections. 
The aim of the study was to evaluate the clinical effect of octenidine dihydrochloride mouthwash added to local oral hygiene care protocol for patients receiving respiratory support. 
Materials and Methods. This prospective cohort study included 299 patients receiving respiratory support in the ICU setting during 2023–2026 years; after propensity score matching (PSM), 208 (104 pairs) patients were included in the final analysis. Oral hygiene protocol included twice-daily tooth brushing and oral rinsing at a frequency determined by the Intensive Care Oral Care Frequency Assessment Scale (ICOCFAS). Octenidine dihydrochloride 0.1% solution was used as the rinse in the study group, and distilled water — in the control group. A dentist assessed oral health using the Challacombe Scale of Clinical Oral Dryness (CSCOD), Plaque Index (PI), and Modified Gingival Index (MGI) at predefined time points. 
Results. During days 1–3, the study group showed a decrease in the median MGI and PI values compared with the control group (p  < 0.001). By day 7, the favorable changes in the MGI and PI in the study group had boosted, and between-group differences remained significant (p  < 0.001). The effect of the intervention did not depend on the clinical outcome: the «group × outcome» interaction was not statistically significant for ∆MGI_1–3 and ∆MGI_1–7 (p = 0.269 and p = 0.141, respectively). Changes in xerostomia (CSCOD) did not differ significantly between the groups (p = 0.119). 
Conclusion. The use of 0.1% octenidine dihydrochloride mouthwash as a part of the oral hygiene protocol in patients receiving respiratory support results in rapid resolution of gingival inflammation (MGI) and effective removal of dental plaque (PI). However, the persisting rigidness of xerostomia (CSCOD) regardless of the hygiene care protocol warrants searching for additional correction strategies. 

1. Candel F.J., Salavert M., Estella A., Ferrer M., Ferrer R., et al. Ten Issues to Update in Nosocomial or Hospital-Acquired Pneumonia: An Expert Review. Journal of clinical medicine. 2023; 12 (20): 6526. DOI: 10.3390/jcm12206526. PMID: 37892664.

2. Kuzovlev A.N., Moroz V.V. Nosocomial pneumonia — principles of early diagnosis and prevention. Annals of Critical Care. 2019; (2): 40–47. (in Russ.). DOI: 10.21320/1818-474X-2019-2-40-47.

3. Satheeshkumar P.S., Papatheodorou S., Sonis S. Enhanced oral hygiene interventions as a risk mitigation strategy for the prevention of non-ventilator-associated pneumonia: a systematic review and meta-analysis. Br Dent J. 2020; 228 (8): 615–622. DOI: 10.1038/s41415-020-1452-7. PMID: 32332964.

4. Jun M.K., Ku J.K., Kim I.H., Park S.Y., Hong J., et al. Hospital Dentistry for Intensive Care Unit Patients: A Comprehensive Review. J Clin Med. 2021; 10 (16): 3681. DOI: 10.3390/jcm10163681. PMID: 34441976.

5. Kitsios G.D., Sayed K., Fitch A., Yang H., Britton N., et al. Prognostic Insights from Longitudinal Multicompartment Study of Host-Microbiota Interactions in Critically Ill Patients. medRxiv [Preprint]. 2023; 26: 2023.09.25.23296086. DOI: 10.1101/2023.09.25.23296086. PMID: 37808745; PMCID: PMC10557814.

6. Bizyaev A.A., Konnov V.V., Pospelov A.N., Krechetov S.A., Maslennikov D.N., Proshin A.G. Features of hygienic care of removable dentures made of thermoplasts. Current Issues in Medicine. 2024; 47 (1): 64–71. (in Russ.). DOI: 10.52575/2687-0940-2024-47-1-64-71.

7. Aranda Gómez M.P., Chaparro Torres E., Hernández Abahunza N.D., Vargas Carreño A.C., Herrera Sandoval L.V., Castellanos Domínguez Y.Z. Oral findings of patients in the intensive care unit:a systematic review. Rev Cuid. 2025; 27: 16 (1): e3959. DOI: 10.15649/cuidarte.3959. PMID: 40529943.

8. Baykulova M.D., Razumova S.N., Brago A.S., Utz N.V., Barakat H.B., Razumov N.M., Myandiev M.S. Oral hygiene for severe care: a literature review. Russian Journal of Dentistry. 2024; 28 (4): 420–431. (in Russ.). DOI: 10.17816/dent633055.

9. Rezaei S., Rezaei K., Mahboubi M., Jarahzadeh M.H., Momeni E., et al. Comparison the efficacy of herbal mouthwash with chlorhexidine on gingival index of intubated patients in Intensive Care Unit. J Indian Soc Periodontol. 2016; 20 (4): 404–408. DOI: 10.4103/0972-124X.194269. PMID: 28298822.

10. Al-Maweri S.A., Nassani M.Z., Alaizari N., Kalakonda B., AlShamiri H.M., et al. Efficacy of aloe vera mouthwash versus chlorhexidine on plaque and gingivitis: A systematic review. Int J Dent Hyg. 2020; 18 (1): 44–51. DOI: 10.1111/idh.12393. PMID: 30829440.

11. Amrita A., Agarwal P., Agarwal M.C., Agarwal A., Garg J., et al. Comparative Evaluation of Octenidine with Chlorhexidine Mouthwash in Gingivitis and Periodontitis Patients: A Randomized Clinical Trial. Journal of pharmacy & bioallied sciences. 2024; 16 (Suppl 1): S789-S791. DOI: 10.4103/jpbs.jpbs_1011_23. PMID: 38595450.

12. Sabanceva E.G., Dmitrieva N.A., Avramenko E.A., Ivanova E.V., Ezhova E.G., Pochivalin V.P. Evaluation of effectiveness of a mouthwash containing antiseptic octenidine dihydrochloride. Stomatology. 2021; 100 (2): 32–39. (In Russ.) DOI: 10.17116/stomat202110002132. PMID: 33874658.

13. Kelly N., Blackwood B., Credland N., Stayt L., Causey C., et al. Oral health care in adult intensive care units: A national point prevalence study. Nurs Crit Care. 2023; 28 (5): 773–780. DOI: 10.1111/nicc.12919. PMID: 37125669.

14. Jun M.K., Ku J.K., Kim I.H., Park S.Y., Hong J., et al. Hospital Dentistry for Intensive Care Unit Patients: A Comprehensive Review. J Clin Med. 2021; 10 (16): 3681. DOI: 10.3390/jcm10163681. PMID: 34441976.

15. Ames N.J., Sulima P., Yates J.M., McCullagh L., Gollins S.L., Soeken K., Wallen G.R. Effects of systematic oral care in critically ill patients: a multicenter study. American journal of critical care: an official publication. American Association of Critical-Care Nurses. 2011; 20 (5): e103–14. DOI: 10.4037/ajcc2011359. PMID: 21885453.

16. Doðu Kökcü Ö., Terzi B. Development of an intensive care oral care frequency assessment scale. Nursing in critical care. 2022; 27 (5): 667–675. DOI: 10.1111/nicc.12529. PMID: 32633044.

17. He T, Qu L, Chang J, Wang J. Gingivitis Models — Relevant Approaches to Assess Oral Hygiene Products. J Clin Dent. 2018; 29 (2): 45–51. PMID: 30211990.

18. Turesky S., Gilmore N.D., Glickman I. Reduced plaque formation by the chloromethyl analogue of victamine C. J Periodontol. 1970; 41 (1): 41–43. DOI: 10.1902/jop.1970.41.41.41. PMID: 5264376.

19. Henriksen B.M., Ambjørnsen E., Axéll T.E. Evaluation of a mucosalplaque index (MPS) designed to assess oral care in groups of elderly. Spec Care Dentist. 1999; 19 (4): 154–157. DOI: 10.1111/j.1754-4505.1999.tb01378.x. PMID: 10765880.

20. Babina, K.S., Borovsky, E.V., Makeeva, I.M. Choice of a method for index assessment of the hygienic state of the oral cavity. Sechenov Medical Journal. 2013; 1 (11): 10–14. (in Russ.).

21. Petrova T.G., Obukhova L.D., Gerasimenko O.N., Zvereva T.V., Ragimova T.M. Сlinical evaluation of xerostomia manifestations in young-old and middle-old age. Parodontologiya. 2023; 28 (4): 380-388 (in Russ.). DOI: 10.33925/1683-3759-2023-834

22. Gonsalves, W. C., Wrightson, A. S., Henry, R. G. Common oral conditions in older persons. American family physician. 2008; 78 (7): 845–852. PMID: 18841733.

23. Vandenbulcke P.A.I., de Almeida Mello J., Schoebrechts E., De Lepeleire J., Declercq A., Declerck D., Duyck J. Oral health of nursing home residents in Flanders, Belgium, and its associated factors. Sci Rep. 2025; 14: 15 (1): 5463. DOI: 10.1038/s41598-025-89910-4. PMID: 39953136; PMCID: PMC11829024.

24. Luo F., Shi W., Fan X., Zhou M., Shen F., Zhu H., Zhu J., et al. Impact of non-invasive ventilation on microbial colonisation patterns in preterm infants: a single-centre study. BMJ Paediatr Open. 2024; 8 (1): e002783. DOI: 10.1136/bmjpo-2024-002783. PMID: 39489525.

25. Rathbun K.P., Sole M.L., Yooseph S., Xie R., Bourgault A.M., et al. Oral Microbiome Changes During Hospitalization in Older Adults Not ReceivingMechanical Ventilation. Am J Crit Care. 2025; 34 (3): 208–217. DOI: 10.4037/ajcc2025470. PMID: 40307181.

26. Collins T., Plowright C., Gibson V., Stayt L., Clarke S., et al. British Association of Critical Care Nurses: Evidence-based consensus paper for oral care within adult critical care units. Nursing in critical care. 2021; 26 (4): 224–233. DOI: 10.1111/nicc.12570. PMID: 33124119.

27. Yao L.Y., Chang C.K., Maa S.H., Wang C., Chen C.C. Brushing teeth with purified water to reduce ventilator-associated pneumonia. J Nurs Res. 2011; 19 (4): 289–297. DOI: 10.1097/JNR.0b013e318236d05f. PMID: 22089654.

28. Marino P.J., Hannigan A., Haywood S., Cole J.M., Palmer N., et al. Comparison of foam swabs and toothbrushes as oral hygiene interventions in mechanically ventilated patients: a randomised split mouth study. BMJ Open Respir Res. 2016; 3 (1): e000150. DOI: 10.1136/bmjresp-2016-000150. PMID: 27843549.

29. Funahara M., Yamaguchi R., Honda H., Matsuo M., Fujii W., et al. Factors affecting the number of bacteria in saliva and oral care methods for the recovery of bacteria in contaminated saliva after brushing: a randomized controlled trial. BMC Oral Health. 2023; 23 (1): 917. DOI: 10.1186/s12903-023-03676-7. PMID: 38001433.

30. Köck R., Denkel, L., Feßler A.T., Eicker R., Mellmann, A., et al. Clinical Evidence for the Use of Octenidine Dihydrochloride to Prevent Healthcare-Associated Infections and Decrease Staphylococcus aureus Carriage or Transmission — Pathogens 2023; 12 (4): 612. DOI: 10.3390/pathogens12040612. PMID: 37111498. PMCID: PMC10145019.

31. Jockel-Schneider Y., Schlagenhauf U., Petsos H., Rüttermann S., et al. Impact of 0.1% octenidine mouthwash on plaque re-growth in healthy adults: a multi-center phase 3 randomized clinical trial. Clinical oral investigations. 2021; 25 (7): 4681–4689. DOI: 10.1007/s00784-021-03781-3. PMID: 33483868.

32. Zhao T., Wu X., Zhang Q., Li C., Worthington H.V., et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2020; 12 (12): CD008367. DOI: 10.1002/14651858.CD008367.pub4. PMID: 33368159.

33. Ruslyakova I.A., Khromova E.A., Zakharova E.A., Kulik I.V., Glushchenko V.A., Silin A.V. A case of effective treatment of oral mucositis associated with antitumor therapy in a critically ill patient. HERALD of NorthWestern State Medical University named after I.I. Mechnikov. 2025; 17 (4): 89–98. DOI: 10.17816/mechnikov676905