We thank Dr Kishimoto et al for their interest in our recent article in CHEST (August 2009)1 regarding dental brushing for preventing ventilator-associated pneumonia (VAP). To our knowledge, this is the first study to evaluate the contribution of an intensive oral hygiene protocol using electric toothbrushing to prevent VAP. Our findings suggest that the addition of a mechanical system with electric toothbrushing to standard oral care with chlorhexidine was not effective in preventing VAP. To the best of our knowledge, no universal recommendation regarding the best way to perform oral care in critically ill patients is available. Therefore, we designed an oral care strategy that includes a multidisciplinary approach (including nurses and an oral care expert), and, after a training period for several intensive care nurses, we started performing the technique described in our article. We appreciate Kishimoto et al’s opinion that in the intervention group (0.12% chlorhexidine digluconate every 8 h, plus tooth and tongue brushing every 8 h), after brushing, deep oropharyngeal suction could be done to remove extricated bacteria. We did not do this; instead, we performed an aspiration of the oral cavity. Munro et al2 used a strategy similar to that performed in our study, with similar results. Whether deep oropharyngeal suction after toothbrushing improves our ability to clean up the oral cavity and further reduces the risk of aspiration should be further documented in prospective studies.