Oral care after stroke: Where are we now?

Abstract

There appears to be an association between poor oral hygiene and increased risk of aspiration pneumoniaa leading cause of mortality post-stroke. We aim to synthesise what is known about oral care after stroke, identify knowledge gaps and outline priorities for research that will provide evidence to inform best practice. Methods: A narrative review from a multidisciplinary perspective, drawing on evidence from systematic reviews, literature, expert and lay opinion to scrutinise current practice in oral care after a stroke and seek consensus on research priorities. Findings: Oral care tends to be of poor quality and delegated to the least qualified members of the caring team. Nursing staff often work in a pressured environment where other aspects of clinical care take priority. Guidelines that exist are based on weak evidence and lack detail about how best to provide oral care. Discussion: Oral health after a stroke is important from a social as well as physical health perspective, yet tends to be neglected. Multidisciplinary research is needed to improve understanding of the complexities associated with delivering good oral care for stroke patients. Also to provide the evidence for practice that will improve wellbeing and may reduce risk of aspiration pneumonia and other serious sequelae. Conclusion: Although there is evidence of an association, there is only weak evidence about whether improving oral care reduces risk of pneumonia or mortality after a stroke. Clinically relevant, feasible, cost-effective, evidence-based oral care interventions to improve patient outcomes in stroke care are urgently needed.

Risk factors for aspiration pneumonia during concurrent chemoradiotherapy or bio-radiotherapy for head and neck cancer

“…Several studies have demonstrated that oral care is associated with a decreased incidence of aspiration pneumonia in elderly people [26][27][28]. We earlier reported that a systematic oral care program for patients with HNC may improve treatment compliance by decreasing the risk of infection [29].…”

Oral Health, Oral Microbiota, and Incidence of Stroke-Associated Pneumonia—A Prospective Observational Study

“…As the dental examinations took place within 24 h of inpatient admission, these results cannot be attributed to insufficient oral care during hospitalization at the stroke unit. On the contrary, it is wellknown that nursing-driven oral hygiene care may be of poor quality during hospitalization, particularly in dependent patients, with oral care procedures often being delegated to the least qualified members of the nursing team (61,62). Consequently, Wagner et al found that implementation of a systematic oral hygiene program significantly reduced incidence of strokeassociated pneumonia in acute stroke patients (63).…”

Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review

“…However, patients who are exclusively fed via the enteral route are also at risk of developing SAP. Tube feeding [13] and poor oral hygiene [14] may increase the risk of pneumonia by promoting bacterial colonization of the oropharynx. The presence of oral and dental disease causes alterations of oropharyngeal flora, and reduced saliva flow increases the bacterial density of the saliva.…”