Oral health promotion interventions among patients following stroke

Abstract

OBJECTIVES: A randomized controlled trial was conducted to evaluate the effectiveness of two oral health promotion interventions in reducing levels of plaque and gingival bleeding among patients with stroke after three months of out-patient rehabilitation. METHODS: After having undergone baseline clinical oral health assessments, patients (n=63) with moderate to severe stroke undergoing out-patient rehabilitation were randomly allocated to receive either (1) a manual toothbrush and oral hygiene instruction (OHI) intervention or (2) a powered toothbrush, 0.2% chlorhexidine gluconate mouthrinse, and OHI intervention. The oral hygiene and gingival status of the subjects were assessed using the Silness and Löe Plaque Index (PI) and the Gingival Bleeding Index (GBI) at baseline and at 3-month follow up. RESULTS: Poor oral hygiene was observed at baseline with a median PI score (interquartile range) of 2.07 (1.81-2.36). There were no significant differences in PI and GBI scores between the two intervention groups at baseline. A total of 20 patients in group 1, and 25 patients in group 2 returned for the 3-month follow-up review. Within group comparisons demonstrated significant reductions in median PI (p=0.025) and GBI (p<0.001) scores at 3 months in the group receiving a powered toothbrush and chlorhexidine, while a significant increase in PI scores (p=0.01) and no significant change in GBI scores were found for patients receiving a manual toothbrush. Reduction in plaque (p=0.03) and bleeding scores (p=0.03) were significantly greater in the group receiving a powered toothbrush and chlorhexidine. The provision of a powered toothbrush, chlorhexidine mouthrinse, and OHI was also found to be acceptable to the majority of patients. CONCLUSIONS: An intervention comprising provision of a powered toothbrush, chlorhexidine mouthrinse, and OHI is more effective than a conventional intervention of providing a manual toothbrush and OHI in reducing dental plaque and gingival bleeding in people undergoing rehabilitation after stroke.