Staff-led interventions for improving oral hygiene in patients following stroke

Glasgow Caledonian University, Nursing, Midwifery and Allied Health Professions Research Unit, Cowcaddens Road, Glasgow, UK.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 02/2006; 4(4):CD003864. DOI: 10.1002/14651858.CD003864.pub2
Source: PubMed

ABSTRACT For people with limitations due to neurological conditions such as stroke, the routine practice of oral care may become a challenge. Evidence-based supported oral care intervention is essential for this patient group.
To compare the effectiveness of staff-led oral care interventions with standard care for ensuring oral hygiene for individuals after a stroke.
We searched the trials registers of the Cochrane Stroke Group and Oral Health Group (August 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE (1966 to February 2006), CINAHL (1982 to February 2006), Research Findings Electronic Register (February 2006), National Research Register (Issue 1, 2006), ISI Science and Technology Proceedings (August 2005), Dissertation Abstracts and Conference Papers Index (August 2005). We scanned reference lists from relevant papers and contacted authors and researchers in the field.
We identified randomised controlled trials that evaluated one or more interventions designed to improve oral hygiene. Trials based on a mixed population were included, provided it was possible to extract the data specific to the individuals post stroke.
Two review authors independently classified identified trials according to the inclusion and exclusion criteria, assessed the trial quality and extracted data. Clarification was sought from study authors when required.
Eight eligible randomised controlled trials were identified but only one provided stroke-specific information. It compared an oral health care education training programme (OHCE) delivered to nursing home care assistants to delayed training intervention in the control group. Comparisons were made at one and six months after the intervention, using the primary outcome measures dental plaque and denture plaque, and three secondary outcomes. The data available for the 67 individuals with a stroke (obtained from the larger cluster randomised controlled trial) showed that denture plaque scores were significantly reduced up to six months (p < 0.00001) after the intervention. Staff knowledge (P = 0.0008) and attitudes (P = 0.0001) towards oral care also improved significantly.
Based on one study with a small number of stroke survivors, providing oral care training for carers in a nursing home setting improves their knowledge of and attitudes towards the provision of oral care. In turn, residents' dentures were cleaner, though other oral hygiene measures did not change. Further evidence relating to oral care interventions is severely lacking, in particular with reference to care in hospital for those following stroke.

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    • "To date, only two randomized control trials have examined oral hygiene protocols in poststroke patients (Brady, Furlanetto, Hunter, Lewis & Milne, 2006; Lam et al., 2013a,b). Brady et al. (2006) demonstrated that an oral care training program provided to home health assistants caring for poststroke patients improved staff attitudes and knowledge toward oral care, but not specific oral hygiene outcome measures. Lam, McMillan, Samaranayake, Li and McGrath (2013a) demonstrated a reduction in oral plaque and gingival bleeding among those subjects who were randomized to the groups that received chlorohexidine rinse. "
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    ABSTRACT: PurposeThe pilot study purpose was to determine the effects of a new standardized oral care protocol (intervention) to usual care practices (control) in poststroke patients.DesignThis study is a randomized controlled clinical trial.Method Fifty-one subjects were enrolled. Subjects in the intervention group received oral care twice a day including tooth brushing, tongue brushing, flossing, mouth rinse, and lip care while control patients received usual oral care.FindingsSubjects in the control and intervention groups showed improvement in their oral health assessments, swallowing abilities and oral intake. There were no significant differences between the two groups. Although not statistically significant, overall prevalence of methicillin-resistant Staphylococcus aureus and methicillin-sensitiveStaphylococcus aureus colonization in the control group almost doubled (from 4.8% to 9.5%), while colonization in the intervention group decreased (from 20.8% to 16.7%).Conclusions/Clinical RelevanceThese findings demonstrate the importance of oral care in the poststroke patient with dysphagia.
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    ABSTRACT: Many groups of patients with disabilities have a higher risk of oral disease due to compromised oral hygiene as a consequence of their impairment, oral manifestations of their particular condition and/or the side effects of drug regimes, notably xerostomia and sugar in medicines. This article looks at education related to oral health and its management for both patients and carers. It will encourage a tailored routine for oral hygiene, taking account of the best time of day for the person concerned, the facilities available to them, appropriate preventive measures and the support and adaptations required to minimise the effect their impairment has on managing their oral hygiene. Additionally, it considers educational issues for the dental team related to some elements of managing oral health of people with disability, the dental team's responsibility in educating other health professionals and the availability of undergraduate and postgraduate education in special care dentistry.
    British dental journal official journal of the British Dental Association: BDJ online 09/2008; 205(3):119-30. DOI:10.1038/sj.bdj.2008.652 · 1.08 Impact Factor
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    ABSTRACT: Background.  Unrefutable evidence now links poor oral health with the development of preventable systemic illnesses and debilitating conditions that threaten quality of life and life itself. This is especially significant for an increasing older population who are dependent on others for care. Aims and objectives.  The majority of studies analysing the oral health of older dependent people in long-term residential care have been undertaken by dental professionals. This critical literature review examines the issue from a nursing perspective because nursing care providers have a fundamental role in daily oral health provision for dependent residents. Conclusions.  Multiple barriers were found to negatively impact on daily oral healthcare provision, including lack of care provider education, oral health values, availability of resources, implementation of supportive policies, documentation and oral health assessment tools. Relevance to clinical practice.  The nursing profession, at all levels, must become pro-active in removing financial, political and workforce barriers that impact negatively on oral health outcomes. A multi-faceted approach is required to address these barriers, including development and implementation of oral health education programmes, assessment screening tools, care plans, documentation, supply of oral hygiene aids and the appointment of oral care 'champions'.
    International Journal of Older People Nursing 06/2009; 4(2):97-113. DOI:10.1111/j.1748-3743.2008.00150.x
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