Abstract
Objective
To evaluate the effectiveness of oral health promotion interventions on clinical oral
health.
Design
Single-blind randomized controlled trial conducted over 3 weeks of in-hospital rehabilitation.
Setting
Stroke rehabilitation ward in Hong Kong.
Participants
Patients with stroke (N=102) admitted to the rehabilitation ward.
Interventions
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.
Results
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.
Conclusions
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.
Keywords
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)To read this article in full you will need to make a payment
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References
- Evidence behind stroke rehabilitation.J Neurol Neurosurg Psychiatry. 2003; 74: iv18-iv21
- Stroke: working toward a prioritized world agenda.Cerebrovasc Dis. 2010; 30: 127-147
- A longitudinal study of the oral health condition of elderly stroke survivors on hospital discharge into the community.Int Dent J. 2005; 55: 319-324
- Oral health-related quality of life of stroke survivors on discharge from hospital after rehabilitation.J Oral Rehabil. 2005; 32: 495-503
- Oral care and stroke units.Gerodontology. 2005; 22: 77-83
- Dysphagia after stroke: incidence, diagnosis, and pulmonary complications.Stroke. 2005; 36: 2756-2763
- Malnutrition, eating difficulties and feeding dependence in a stroke rehabilitation centre.Disabil Rehabil. 2006; 28: 637-643
- Risk factors for chest infection in acute stroke: a prospective cohort study.Stroke. 2007; 38: 2284-2291
- Xerostomia after acute stroke.Cerebrovasc Dis. 2009; 28: 624-626
- Oral health care for the stroke survivor.J Calif Dent Assoc. 1997; 25: 297-303
- Oral stereognosis in stroke and Parkinson's disease: a comparison of partially dentate and edentulous individuals.Clin Oral Investig. 2001; 5: 112-117
- Swallowing and stroke. Neurological effects and recovery.Cerebrovasc Dis. 2002; 14: 1-8
- Stroke and the dental patient.J Am Dent Assoc. 1994; 125: 721-727
- Oral care for patients with cardiovascular disease and stroke.J Am Dent Assoc. 2002; 133: 37S-44S
- Oral health-related quality of life after stroke.Univ of Hong Kong, Hong Kong2007
- Staff-led interventions for improving oral hygiene in patients following stroke.Cochrane Database Syst Rev. 2006; Oct 18: CD003864
- Improving oral health in institutionalised elderly people by educating caregivers: a randomised controlled trial.Community Dent Oral Epidemiol. 2001; 29: 289-297
- The association of gingivitis and periodontitis with ischemic stroke.J Clin Periodontol. 2004; 31: 396-401
- Periodontitis as a risk factor for cerebrovascular accident: a case-control study in the Indian population.J Periodontal Res. 2010; 45: 223-228
- Periodontitis and the risk for non-fatal stroke in Korean adults.J Periodontol. 2008; 79: 1652-1658
- Association between periodontal disease and stroke.J Vasc Surg. 2012; 55: 1178-1184
- Colonization of dental plaques: a reservoir of respiratory pathogens for hospital-acquired pneumonia in institutionalized elders.Chest. 2004; 126: 1575-1582
- Genetic relationships between respiratory pathogens isolated from dental plaque and bronchoalveolar lavage fluid from patients in the intensive care unit undergoing mechanical ventilation.Clin Infect Dis. 2008; 47: 1562-1570
- Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. A systematic review.Ann Periodontol. 2003; 8: 54-69
- The effect of pneumonia on mortality among patients hospitalized for acute stroke.Neurology. 2003; 60: 620-625
- Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients. A prospective study based on genomic DNA analysis.Am J Respir Crit Care Med. 1997; 156: 1647-1655
- Stroke-associated infection is an independent risk factor for poor outcome after acute ischemic stroke: data from the Netherlands Stroke Survey.Cerebrovasc Dis. 2009; 27: 465-471
- Review of the evidence to support oral hygiene in stroke patients.Nurs Stand. 2010; 24: 35-38
- Functional evaluation: the Barthel Index.Md State Med J. 1965; 14: 61-65
- Cognitively impaired stroke patients do benefit from admission to an acute rehabilitation unit.Arch Phys Med Rehabil. 2008; 89: 441-448
- The Gingival Index, the Plaque Index and the Retention Index Systems.J Periodontol. 1967; 38: 610-616
- Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condtion.Acta Odontol Scand. 1964; 22: 121-135
- Problems and proposals for recording gingivitis and plaque.Int Dent J. 1975; 25: 229-235
- Periodontal conditions in subjects following orthodontic therapy. A preliminary study.Eur J Orthod. 2007; 29: 477-481
- Effect of periodontal treatment on metabolic control, systemic inflammation and cytokines in patients with type 2 diabetes.J Clin Periodontol. 2010; 37: 53-58
- The plaque-removing efficacy of an oscillating/rotating toothbrush. A short-term study.J Clin Periodontol. 1993; 20: 273-278
- The long-term effect of an oscillating/rotating electric toothbrush on gingivitis. An 8-month clinical study.J Clin Periodontol. 1994; 21: 139-145
- Validity, reliability and responsivity of the Royal Brisbane Hospital Outcome Measure for Swallowing.Asia Pac J Speech Lang Hear. 1999; 4: 109-129
- Missing outcomes in randomized trials: addressing the dilemma.Open Med. 2009; 3: e51-e53
- Applied multivariate research: design and interpretation.Sage Publications, Thousand Oaks2006
- Electric or manual toothbrush? A comparison of the effects on the oral health of mentally handicapped adults.Clin Prev Dent. 1988; 10: 23-26
- Statistics in dentistry.British Dental Association, London1989
- Intra-/inter-examiner reproducibility study of gingival bleeding.J Periodontal Res. 1994; 29: 236-241
- Professional flossing as a diagnostic method for gingivitis in the primary dentition.Braz Oral Res. 2008; 22: 316-321
- Reproducibility of bleeding tendency measurements and the reproducibility of mouth bleeding scores for the individual patient.J Periodontal Res. 1986; 21: 653-659
- The influence of examination of the assessment of the intra-examiner error by using the plaque and gingival index systems.Community Dent Oral Epidemiol. 1975; 3: 214-216
- Manual versus powered toothbrushing for oral health.Cochrane Database Syst Rev. 2005; Apr 18: CD002281
- Efficacy of a sonic toothbrush for plaque removal by caregivers in a special needs population.Spec Care Dentist. 1998; 18: 202-206
- Improvement of oral hygiene in patients with rheumatoid arthritis.Scand J Dent Res. 1992; 100: 172-175
- Comparison of the Interplak and manual toothbrushes in a population with mental retardation/developmental disabilities (MR/DD).Spec Care Dentist. 1997; 17: 133-136
- Randomized controlled clinical trials on agents used for chemical plaque control.Int J Dent Hyg. 2005; 3: 162-178
- An epidemiological study of child health and nutrition in a northern Swedish county. VI. Relationship between general and oral health, food habits, and socioeconomic conditions.Am J Clin Nutr. 1971; 24: 1361-1373
- Plaque minerals in the prediction of caries activity.Community Dent Oral Epidemiol. 2002; 30: 61-69
- The distribution of plaque and gingivitis and the influence of toothbrushing hand in a group of South Wales 11–12 year-old children.J Clin Periodontol. 1987; 14: 564-572
- Hand function and oral hygiene in older institutionalized Brazilians.J Am Geriatr Soc. 2007; 55: 1333-1338
- Periodontal diseases in Europe.Periodontol. 2000; 2002: 104-121
- Periodontal diseases in the United States population.J Periodontol. 1998; 69: 269-278
- Oral health status in the United States: prevalence of inflammatory periodontal diseases.J Dent Educ. 1985; 49: 354-367
- Assessing quality of life in older adults with cognitive impairment.Psychosom Med. 2002; 64: 510-519
- ‘Not knowing where I am doesn't mean I don't know what I like’: cognitive impairment and quality of life responses in elderly people.Int J Geriatr Psychiatry. 1999; 14: 776-783
- Medical complications during stroke rehabilitation.Stroke. 1995; 26: 990-994
- Incidence and risk factors of medical complications during inpatient stroke rehabilitation.Chang Gung Med J. 2005; 28: 31-38
- Incidence of and risk factors for medical complications during stroke rehabilitation.Stroke. 2001; 32: 523-529
- Medical complications experienced by a cohort of stroke survivors during inpatient, tertiary-level stroke rehabilitation.Arch Phys Med Rehabil. 2004; 85: 466-469
- Frequency of videofluoroscopic modified barium swallow studies and pneumonia in stroke rehabilitation patients: a comparative study.Arch Phys Med Rehabil. 1999; 80: 294-298
- Complications after acute stroke.Stroke. 1996; 27: 415-420
- Medical and neurological complications during inpatient stroke rehabilitation.Stroke. 1994; 25: 358-361
Article info
Publication history
Published online: November 05, 2012
Footnotes
Supported by the Committee of Research and Conference Grants of the University of Hong Kong.
Hong Kong Clinical Trial Register No.: HKCTR-1159.
United States National Institutes of Health Clinical Trial Registry No.: NCT01265043.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
