Article

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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