Effect of a collaborative transdisciplinary team approach on oral health status in acute stroke patients

Abstract

Background Oral function deteriorates easily during the acute phase of cerebral stroke. Therefore, oral health care involving a transdisciplinary approach consisting of dental and medical professionals might be important, but has not been studied in detail. Objective This study assessed the oral health status of patients with cerebral stroke in the acute phase, with the aim of elucidating the efficacy of collaborative, transdisciplinary oral health care involving dentists, dental hygienists, nurses and speech therapists. Methods The participants were 115 consecutive acute cerebral stroke patients, who received oral health care while hospitalised at the university hospital. Their oral health status was assessed using the oral health assessment tool (OHAT) on admission and discharge. Results Patients with acute cerebral stroke had high OHAT scores on admission, meaning poor oral health status. The collaborative oral health care resulted in significant decrease of OHAT scores at discharge, indicative of the improvement of oral health status. Multivariate analysis identified OHAT score for tongue, dentures and oral cleanliness on admission as the significant variables associated with poor oral health status at discharge. Conclusions Thus, the oral health of cerebral stroke patients in the acute phase can be improved by implementing transdisciplinary collaboration of medical and dental professionals. Particularly, patients with problems pertaining to the tongue, dentures and oral cleanliness as revealed through OHAT on admission may require more intensive intervention.

Food intake and oral health status of inpatients with dysphagia in acute care settings

“…Furthermore, many patients had not been performing proper plaque control. These findings confirm the recent reports wherein a large percentage of inpatients admitted to acute care hospitals had problems with their oral statuses and functions, 12 resulting in the need to provide oral care 27 through interdisciplinary collaboration and active dental interventions.…”

“…The oral intake levels of our patients were affected not only by the level of consciousness, ADL, swallowing functions and lingual functions, but also by the posterior occlusal support, including denture status. In acute care hospitals, dentures are often removed because of management complexities, risk of aspiration or swallowing, and to prevent disturbances in sensory perception 12 . However, the presence of removable denture improves the masticatory ability 30 and the oral anatomical environment, and it may potentially play a role in supporting oral cavity and pharyngeal movements during oral intake, including bolus transportation and elevation of the hyoid bone in swallowing function training 31,32 .…”

“…Kakinoki et al’s 20 classification of oral dryness severity was scored as follows: 0 = absence of oral dryness (normal), 1 = an increased salivary viscosity (mild), 2 = finding of a foamy saliva (moderate) and 3 = a near‐absence of saliva (severe). Plaque control was classified as "good," "slightly poor" and "poor" based on previous studies 12 . The use of dentures was grouped into four different categories as follows: "does not need a denture," "does not own a denture," "owns a denture but does not use it" and "uses dentures."…”

“…However, inpatients with dysphagia, particularly elderly patients, have poor oral health and hygiene with a high prevalence of caries, periodontal disease and edentulous jaws 11 . In addition, inpatients in acute care hospitals, particularly patients with cerebrovascular disorders, tend to have rapid deterioration of their oral status and function 12 from impaired consciousness and long‐term lack of oral care (including dentures) during medical treatment. Hence, it is essential to provide proper oral care, to implement efforts to recover chewing ability through dental treatment, and to improve the general oral status and function.…”

Comparison of perceptions, attitudes and performance regarding collaborative oral health care among health-care workers

“…Collaborative oral health care by health-care workers (HCWs), for patients in hospitals or residents in elderly care facilities, is important, not only to prevent oral complications but also to prevent systematic diseases, such as pneumonia and cardiovascular disease [12][13][14] . Problems with different perceptions of oral health care among HCWs may occur in such facilities.…”