A randomized clinical trial on the effect of Oral Health Promotion interventions among patients following stroke

Abstract

AIMS: A randomized controlled trial was conducted to evaluate the effectiveness of two oral health promotion interventions in reducing levels of plaque, gingival bleeding, and prevalence of oral yeasts among patients with stroke after three months of rehabilitation. METHODS: Patients (n=63) with moderate to severe stroke undergoing rehabilitation were randomly allocated to receive either (1) a manual toothbrush and oral hygiene instruction (OHI) or (2) a powered toothbrush, 0.2% chlorhexidine gluconate mouthrinse, and OHI. Oral microbiological sampling to detect oral carriage of yeasts and clinical assessment were conducted both at baseline and at 3 months. RESULTS: There were no significant differences in the percentages of sites with moderate to abundant plaque and sites with bleeding between the two groups at baseline. Among 54 patients scheduled for the 3-month review, a total of 19 patients in group 1, and 25 patients in group 2 returned. Within group comparisons demonstrated significant reductions both in the percentages of sites with moderate to abundant plaque (p<0.001) and bleeding (p<0.001) at 3 months in the group receiving a powered toothbrush and chlorhexidine, while only a significant reduction in the percentage of sites with moderate to abundant plaque (p=0.001) was found for patients receiving a manual toothbrush. Reduction in the percentages of sites with moderate to abundant plaque (p=0.006) and bleeding (p=0.003) were significantly greater in the group receiving a powered toothbrush and chlorhexidine. No significant difference in the percentage of patients who harbored yeasts was observed between the two groups at 3 months. Conclusions: An intervention comprising provision of a powered toothbrush, chlorhexidine mouthrinse, and OHI is more effective in reducing dental plaque and gingival bleeding in patients undergoing rehabilitation after stroke; however, there was no significant difference in the effectiveness of the two different oral hygiene interventions on the prevalence of oral yeasts. (Supported by Research Grants Council of Hong Kong, General Research Fund Project No. 774012).