Original article| Volume 94, ISSUE 3, P435-443, March 2013

Randomized Clinical Trial of Oral Health Promotion Interventions Among Patients Following Stroke

Published:November 05, 2012DOI:



      To evaluate the effectiveness of oral health promotion interventions on clinical oral health.


      Single-blind randomized controlled trial conducted over 3 weeks of in-hospital rehabilitation.


      Stroke rehabilitation ward in Hong Kong.


      Patients with stroke (N=102) admitted to the rehabilitation ward.


      Patients were randomly assigned either: (1) oral hygiene instruction, (2) oral hygiene instruction and chlorhexidine mouthrinse, or (3) oral hygiene instruction, chlorhexidine mouthrinse, and assisted brushing.

      Main Outcome Measures

      Dental plaque, gingival bleeding, and oral functional status were assessed at baseline and review. Development of infectious complications were also monitored during the clinical trial.


      Poor oral hygiene and an overall neglect of oral hygiene practices were observed at baseline. Reductions in dental plaque were significantly greater in the 2 groups receiving chlorhexidine compared with the group receiving oral hygiene instruction alone (P<.001). Reductions in gingival bleeding scores were 3- to 4-fold greater in groups receiving chlorhexidine. No cases of pneumonia were observed during the course of the clinical trial.


      The oral health condition of patients may be safeguarded after acute stroke with the use of chlorhexidine mouthrinse in conjunction with a standard mechanical plaque removal tool, such as an electric toothbrush. These interventions are acceptable to the majority of patients, and their administration poses a minimal burden to rehabilitation ward staff.


      List of abbreviations:

      BI (Barthel Index), CHX (chlorhexidine), GBI (Gingival Bleeding Index), IQR (interquartile range), MMSE (Mini-Mental State Examination), OHI (oral hygiene instruction), OHP (oral health promotion), PI (plaque index), RCT (randomized controlled trial)
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