The purpose of this study is to compare how effective different ways of mouth cleaning are for patients in a neuroscience intensive care unit with a breathing tube in their mouth.

Patients with neurological dysfunction requiring intubation and ventilation are at risk for developing ventilator acquired pneumonia. Several studies have suggested that oral hygiene plays a role in the subsequent development of pneumonia for patients in the intensive care unit requiring intubation and mechanical ventilation.

Inclusion Criteria:

• > or equal 18 years old
• Intubated within 24hours of admission to the Neuroscience ICU
• Intubation anticipated to continue for approximately 72 hours

Exclusion Criteria:

• Minors
• Pregnancy
• Acute cervical spinal cord injury
• Severe facial trauma
• Family not present for consent