Randomized trial on oral health promotion among stroke rehabilitation patients

Abstract

OBJECTIVES: To evaluate the effectiveness of two oral health promotion interventions in reducing: (1) levels of plaque and gingival bleeding, and (2) prevalence and viable counts of oral opportunistic pathogens among patients undergoing outpatient stroke rehabilitation. METHODS: Participants were randomized to receive either: (1) a powered toothbrush, 0.2% chlorhexidine mouthrinse, and oral hygiene instruction (OHI), or (2) a manual toothbrush and OHI for three months. After the interventional period, the subjects were followed up for another three months. Oral hygiene and gingival status of the participants were assessed using the Silness and Löe Plaque Index (PI) and the Gingival Bleeding Index (GBI). Oral rinse samples were inoculated for detection of aerobic and facultatively anaerobic Gram-negative bacilli (AGNB), yeasts, and Staphylococcus aureus by biochemical identification systems, and 16s rRNA sequencing. RESULTS: This study included 94 subjects at baseline. After the interventional period, there were significantly greater reductions in the percentages of sites with moderate to abundant plaque (PI score= 2 or 3, p< 0.001) and gingival bleeding (p= 0.004) in group 1 compared to group 2. After six months, in group 1 the percentage of sites with moderate to abundant plaque remained significantly lower (p= 0.02) while the percentages of sites with gingival bleeding were similar for the two groups. The percentages of subjects identified with oral opportunistic pathogens were not significantly different between the two groups at both follow-up reviews. However, patients in group 1 harbored significantly fewer viable counts of AGNB both after 3 and 6 months (both p< 0.05), as well as yeasts after 3 months (p= 0.02) compared to group 2. CONCLUSIONS: A combined package of mechanical and chemotherapeutic oral care compared to a mechanical oral care alone is more effective in reducing plaque, gingival bleeding, and preventing the proliferation of some opportunistic pathogens among patients in stroke rehabilitation.