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Randomized clinical trial of oral health promotion interventions among patients following stroke
Otto L Lam1, Anne S McMillan, Lakshman P Samaranayake
1Oral Rehabilitation, Faculty of Dentistry, University of Hong Kong, Hong Kong, China.
Objective:
To evaluate the effectiveness of oral health promotion interventions on clinical oral health.
Design:
Single-blind randomized controlled trial conducted over 3 weeks of in-hospital rehabilitation.
Setting:
Stroke rehabilitation ward in Hong Kong.
Participants:
Patients with stroke (N=102) admitted to the rehabilitation ward.
Interventions:
Patients were randomly assigned either: (1) oral hygiene instruction, (2) oral hygiene instruction and chlorhexidine mouthrinse, or (3) oral hygiene instruction, chlorhexidine mouthrinse, and assisted brushing.
Main Outcome Measures:
Dental plaque, gingival bleeding, and oral functional status were assessed at baseline and review. Development of infectious complications were also monitored during the clinical trial.
Results:
Poor oral hygiene and an overall neglect of oral hygiene practices were observed at baseline. Reductions in dental plaque were significantly greater in the 2 groups receiving chlorhexidine compared with the group receiving oral hygiene instruction alone (P<.001). Reductions in gingival bleeding scores were 3- to 4-fold greater in groups receiving chlorhexidine. No cases of pneumonia were observed during the course of the clinical trial.
Conclusions:
The oral health condition of patients may be safeguarded after acute stroke with the use of chlorhexidine mouthrinse in conjunction with a standard mechanical plaque removal tool, such as an electric toothbrush. These interventions are acceptable to the majority of patients, and their administration poses a minimal burden to rehabilitation ward staff.
