A randomized clinical trial of oral hygiene care programmes during stroke rehabilitation

Abstract

OBJECTIVES: The primary objectives of this study were to evaluate and compare the effectiveness of a conventional oral hygiene care programme (COHCP) and an advanced oral hygiene care programme (AOHCP) in terms of oral hygiene, gingival bleeding, subjective health status and levels of oral opportunistic pathogens. The secondary objectives were to determine and compare the effect of participating in the oral hygiene care programmes, 3 months after the clinical trial (6 months from baseline), in terms of these attributes. METHODS: A total of 94 subjects were block randomized to receive (i) the COHCP comprising manual tooth brushing (with a supply of standardized tooth brushes, tooth paste and oral hygiene instruction) or (ii) the AOHCP comprising powered tooth brushing and mouth rinsing with chlorhexidine (with a supply of standardized power tooth brushes, mouth rinse, tooth paste and oral hygiene instruction). Oral hygiene status, gingival bleeding, subjective health status in terms of health- and oral health-related quality of life (HRQoL and OHRQoL) and oral opportunities pathogens were assessed at baseline, at the end of the clinical trial (3 months) and at the end of the observation period (6 months from baseline). RESULTS: The response rate to the clinical trial was 78.7% (74/94). Participants of both programmes had a significant reduction in the % of sites with moderate to abundant dental plaque (p<0.001) and percentage of sites with gingival bleeding (p<0.05). Those in the AOHCP had significantly less plaque (p<0.001) and less gingival bleeding (p<0.001) at the end of the clinical trial period than those in the COHCP, controlling for other factors. Participants of both programmes had a significant improvements in HRQoL: physical health scores (p<0.05) and mental health scores: (p<0.05). Those in the AOHCP had significantly higher physical health scores (p<0.05) at the end of the clinical trial period than those in the COHCP, controlling for other factors. There was a significant improvement in OHRQoL among participants of the AOHCP (p<0.05) but no significant change among participants of the COHCP (p>0.05). Those in the AOHCP had significantly higher OHRQoL scores (based on one of the indicators at the end of the clinical trial period) than those in the COHCP (p<0.01), controlling for other factors. There was no significant difference in the prevalence and viable counts of oral pathogens: AGNB, yeasts or S. aureus from baseline to the end of the clinical trial period within each group. At the end of the observational period, those in the AOHCP had significantly less plaque (p<0.05), less gingival bleeding (p<0.01), better physical health (p<0.05), and better OHRQoL (p<0.05) (as assessed by two of the indicators), controlling for other factors. Conclusions: Both oral hygiene care programmes were effective in terms of plaque and gingival bleeding control. The AOHCP was more effective than the COHCP. Plaque and gingival bleeding levels were lower and subjective health better (HRQoL and OHRQol) among participants of AOHCP than participants of the COHCP at the end of the clinical trial period and 3-months after the clinical trial.