The effect of oral care interventions in stroke survivors

Abstract

Background and aims: Despite the importance of good oral health, oral health is often neglected among stroke survivors. As a result, periodontal diseases are commonly reported among stroke survivors due to poor oral hygiene and increase in dental plaque . In addition, poor oral health increase carriage of oral pathogens and the risk for opportunistic infection such as aspiration pneumonia . Thus maintenance of good oral health is of key importance to reduce the risk of infection following stroke. Objective: This study aimed to evaluate the effectiveness of an oral health care intervention in improving the oral hygiene and decreasing oral opportunistic pathogens in post stroke patients. Methods: A multi-centre randomized controlled trial was conducted among 86 hospitalised stroke survivors. The inclusion criteria were patients with Modified Barthel Index (MBI) score of less than 70, who were medically stable and able to follow simple instructions. In addition, patients who were not on any antibiotic or antimicrobial agents and of having dentition of not less than five were included into the study. Written informed consent were obtained from all participants before the study commenced. Patients were then randomized into either the i) Test group - who were given a powered toothbrush and antimicrobial gel [1% chlorhexidine gluconate], or ii) Control group - who were given a manual toothbrush and a commercial toothpaste. Oral health assessments and oral microbial sampling using oral rinsing methods were conducted on each patients at three-time points; baseline (before the intervention), 3months and 6-months following interventions. Results: A total of 54 (response rate of 62.7%) patients were assessed at the three-time points. More than half of the participants were male (n=52, 60.5%) and at the age of above 40 (n=73, 84.9%). More than three-quaters of them did not have a denture (n=68, 79.1%), did not take alcohol (n=73, 84.9%) and did not smoke (n=66, 76.7%). For most, it was their first-stroke (n=75, 89.5%) and was of the ischemic type (n=77, 89.5%). Most (n=61, 70.9%) had a MBI scores of less than 50 (total and severe dependency level). Dental plaque scores were significantly lower at 6-months for both groups compared to baseline (P<0.001). Based on microorganism limit of detection (LOD), all participants showed the presence of yeasts, and 88.4% of them haboured S.aureus at baseline. There was a significant difference in yeast prevalence between the control and test group at 6-months (P=0.032), but was not significant within groups changes. A significant difference in S.aureus prevalence within the test group (P=0.024) was observed, however the prevalence was not significantly different between the control and test group at 6-months. Conclusion: The oral care interventions were effective in reducing dental plaque scores among stroke survivors over 6-months. Futhermore, changes in S.aureus over time were apparent and between group differences in yeast prevalence existed at 6-months. The effectiveness of the oral care interventions were comparable for both groups; i) a powered toothbrush and 1% Chlorhexidine gel or ii) a manual toothbrush and commercial toothpaste. The findings have implications for incorporation oral hygiene regimes within stroke rehabilitation.