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: 6.03).
02/2006; 4(4):CD003864. DOI: 10.1002/14651858.CD003864.pub2
A clean mouth not only feels good but the practice of oral hygiene (removing dental plaque and traces of food) is a crucial factor in maintaining the health of the mouth, teeth and gums. A clean and healthy mouth will also prevent pain or discomfort and allow people to eat a range of nutritious foods. Maintaining good oral hygiene may be difficult after a stroke and healthcare staff may have to assist in providing such care. This review of three studies involving 470 participants found little evidence of how this care is best delivered. Information on a small number of nursing home residents who had a stroke (67 participants from a larger trial) showed that training nursing staff improved their knowledge of oral care and resulted in improved oral hygiene in their patients. Another trial demonstrated the beneficial impact of a decontamination gel on the incidence of pneumonia amongst patients in a stroke ward. However, there was no other information on how best to provide oral hygiene and more studies are urgently needed.
Available from: Maureen Musto
- "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.
Available from: Krista van Mourik
- "Compassionate care will help improve the relationship between dentist and patient and between nurse and resident, and may increase the nurse’s willingness to support residents with their oral care. As a result, two of the most frequently reported barriers to oral health care support by nursing staff, lack of prioritization and unfavorable oral healthcare attitude [69,75,77-79], may be mitigated. "
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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.
Available from: John Norrie
- "Before any new OHC intervention can be developed and evaluated there needs to be a strong theoretical underpinning for that intervention . Undertaking a considerable programme of pre-clinical work  we conducted a Cochrane systematic review and found a very limited evidence base . Stroke specific data from a small randomised controlled trial (RCT) of an OHC educational intervention for staff based in a nursing home setting reported positive benefits to residents' denture cleanliness (but not dental cleanliness) as a result of a staff training intervention [8,9]. "
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ABSTRACT: Many interventions delivered within the stroke rehabilitation setting could be considered complex, though some are more complex than others. The degree of complexity might be based on the number of and interactions between levels, components and actions targeted within the intervention. The number of (and variation within) participant groups and the contexts in which it is delivered might also reflect the extent of complexity. Similarly, designing the evaluation of a complex intervention can be challenging. Considerations include the necessity for intervention standardisation, the multiplicity of outcome measures employed to capture the impact of a multifaceted intervention and the delivery of the intervention across different clinical settings operating within varying healthcare contexts. Our aim was to develop and evaluate the implementation of a complex, multidimensional oral health care (OHC) intervention for people in stroke rehabilitation settings which would inform the development of a randomised controlled trial.
After reviewing the evidence for the provision of OHC following stroke, multi-disciplinary experts informed the development of our intervention. Using both quantitative and qualitative methods we evaluated the implementation of the complex OHC intervention across patients, staff and service levels of care. We also adopted a pragmatic approach to patient recruitment, the completion of assessment tools and delivery of OHC, alongside an attention to the context in which it was delivered.
We demonstrated the feasibility of implementing a complex OHC intervention across three levels of care. The complementary nature of the mixed methods approach to data gathering provided a complete picture of the implementation of the intervention and a detailed understanding of the variations within and interactions between the components of the intervention. Information on the feasibility of the outcome measures used to capture impact across a range of components was also collected, though some process orientated uncertainties including eligibility and recruitment rates remain to be further explored within a Phase II exploratory trial.
Complex interventions can be captured and described in a manner which facilitates evaluation in the form of exploratory and subsequently definitive clinical trials. If effective, the evidence captured relating to the intervention context will facilitate translation into clinical practice.
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