It is shocking to learn about hospital nurses' standards for taking care of their patients' oral cavities. The concern we as hygienists have for the health of our patients' mouths is not shared by many nurses. This is an increasing problem within intensive care units because most of the patients are unconscious and cannot perform daily plaque removal for themselves. Nurses are not carrying out the duty for them, which allows the accumulation of pathogenic bacteria within dental plaque. The biofilm attaches to the endotracheal tube and is subsequently able to dislodge and travel into the patient's lungs, causing ventilator-associated pneumonia (VAP). VAP is currently the most commonly occurring nosocomial infection developing among patients with endotracheal tubes. It occurs in patients who are on mechanical ventilators for longer than 48 hours and can become a costly and life-threatening problem. VAP is a real concern to us due to its association with poor oral hygiene in hospitals as well as the significant cost attributed to this illness. Poor oral hygiene in hospitals accounts for bacteria found within dental plaque and periodontal spaces that accumulates and is able to convert to a more virulent form that causes pneumonia. Gram-positive streptococci predominate in the normal flora in the oropharynx. If left undisturbed, these can convert to gram-negative organisms that are more pathogenic. (1) Specifically, VAP can be caused by Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Pseudomonas species. (2) As the oral cavity becomes colonized with aerobic gram-negative bacteria, contaminated secretions, such as saliva, access the trachea, as well as the surface of the endotracheal tube and can later be dislodged and aspirated into the lungs.