Nurses who work in a critical care area face many challenges within their daily role of caring for very sick patients in a stressful and high-tech environment. Underpinning their advanced skills should be a broad base of fundamental nursing skills that has been formulated from research-based evidence. It is, however, the author's belief that oral hygiene - a crucial nursing skill - is not always provided using research-based practice. For this reason, a critical analysis of the issues surrounding the provision of oral hygiene to orally intubated patients within intensive care may provide useful indicators of how the problem could be addressed. This paper considers why orally intubated patients are at particular risk of developing oral health problems, the use of oral assessment tools and the various techniques employed in oral cleansing. The consequences for the patient of poor oral care will also be discussed.