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; 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.

  • Source
    [Show abstract] [Hide abstract]
    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.
    11/2014; 39(6). DOI:10.1002/rnj.154
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Frailty has been demonstrated to negatively influence dental service-use and oral self-care behavior of older people. The aim of this study was to explore how the type and level of frailty affect the dental service-use and oral self-care behavior of frail older people. We conducted a qualitative study through 51 open interviews with elders of varying frailty in the East-Netherlands, and used a thematic analysis to code transcripts, discussions and reviews of the attributes and meaning of the themes to the point of consensus among the researchers. Three major themes and five sub-themes emerged from our analyses. The major themes indicate that frail elders: A) favor long-established oral hygiene routines to sustain a sense of self-worth; B) discontinue oral hygiene routines when burdened by severe health complaints, in particular chronic pain, low morale and low energy; and C) experience psychological and social barriers to oral health care when institutionalized. The subthemes associated with the discontinuation of oral care suggest that the elders accept more oral pain or discomfort because they: B1) lack belief in the results of dental visits and tooth cleaning; B2) trivialize oral health and oral care in the general context of their impaired health and old age; and B3) consciously use their sparse energy for priorities other than oral healthcare. Institutionalized elderly often discontinue oral care because of C1) disorientation and C2) inconveniencing social supports. The level and type of frailty influences people's perspectives on oral health and related behaviors. Frail elders associate oral hygiene with self-worth, but readily abandon visits to a dentist unless they feel that a dentist can relieve specific problems. When interpreted according to the Motivational Theory of Life Span Development, discontinuation of oral care by frail elderly could be viewed as a manifestation of adaptive development. Simple measures aimed at recognizing indicators for poor oral care behavior, and providing appropriate information and support, are discussed.
    BMC Oral Health 11/2013; 13(1):61. DOI:10.1186/1472-6831-13-61 · 1.15 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to describe a new dental hygiene education program for nursing staff and to report experiences from the program at a nursing home in Stockholm, Sweden (2006). This strategy comprises 3 steps. The first is individual instruction for nursing staff about oral care for patients and hands-on training in toothbrushing technique using an electric toothbrush. The second step was small discussion groups of 4 to 8 nursing staff, led by a dental hygienist and a psychologist. The third step was a theoretical lecture focusing on the associations among dental hygiene, oral health, and general health among the elderly. During the dental hygiene education program, a negative attitude toward oral care was noted among members of the nursing staff, although they did consider oral care important for their patients. Increased self-confidence of staff in providing oral care was noted after completing the dental hygiene education program. Nursing staff members stated that they had received more detailed knowledge about oral care during the program. This dental hygiene education program appears to result in increased knowledge and interest in oral hygiene tasks among the nursing staff and may lead to improved dental hygiene among nursing home residents.
    Geriatric nursing (New York, N.Y.) 09/2009; 30(5):329-33. DOI:10.1016/j.gerinurse.2009.06.009 · 0.92 Impact Factor