Effect of an Oral Health Programme on Oral Health, Oral Intake, and Nutrition in Patients with Stroke and Dysphagia in Taiwan: A Randomised Controlled Trial

Abstract

No previous studies have evaluated an oral health programme, before swallowing therapy, in patients with stroke and dysphagia in Taiwan. This randomised controlled trial evaluated the effect of an oral health programme (i.e., sputum assessment, Bass method-based tooth brushing, and tooth coating with fluoride toothpaste) before swallowing therapy. Sixty-six patients with stroke (23 female, 43 male) in our rehabilitation ward, who underwent nasogastric tube insertion, were assigned randomly to an oral care group (n = 33) and a control group (n = 33). Demographic data, oral health assessment, Functional Oral Intake Scale (FOIS) scores, Mini-Nutritional Assessment-Short Form (MNA-SF) scores, and nasogastric tube removal rates were compared between groups. We evaluated outcomes using generalised estimating equation analysis. Three weeks post-implementation, the oral care group had significant oral health improvements relative to the control group (95% CI =−2.69 to −1.25, Wald χ2 = 29.02, p < 0.001). There was no difference in the FOIS (95% CI = −0.16 to 0.89, Wald χ2 = 1.86, p > 0.05), MNA-SF (95% CI = −0.35 to 0.53, Wald χ2 =−0.17, p > 0.05), and nasogastric tube removal (p > 0.05) between groups. The oral care group had a higher, but non-significant FOIS score (3.94 vs 3.52) (p > 0.05). Routine oral health programmes implemented during stroke rehabilitation in patients with dysphagia may promote oral health and maintain oral intake.

Effects of Oral Health Interventions in People with Oropharyngeal Dysphagia: A Systematic Review

“…The methodological quality of six studies was ranked as “strong” [ 35 , 36 , 37 , 38 , 39 , 40 ], and two studies were ranked as “good” [ 41 , 42 ]; no studies were excluded due to poor methodological study quality. Four studies were classified as level II evidence [ 35 , 36 , 37 , 41 ], and four were classified as level III evidence [ 38 , 39 , 40 , 42 ], based on the NHMRC evidence hierarchy level of evidence [ 34 ].…”

“…Only one study included children (N = 24), representing 4% of all participants [ 41 ]. The intervention settings varied for adults, including in-patient hospital wards [ 38 , 42 ], rehabilitation centers [ 35 , 37 , 39 ], and nursing homes [ 36 , 40 ]. The one study that included children delivered the intervention in the child’s home [ 41 ].…”

Management Dysphagia in Post-Stroke Patients Recommendations for Indonesian Nursing Intervention Standards: A Literature Review

“…Articles on early screening of dysphagia by nurses and using formal guidelines can treat dysphagia patients to reduce chest infections and mortality 9 , As for oral nurses proven to reduce aspiration pneumonia. 10,11 Modifying diet with thickeners of fluids and foods reduced the risk of aspiration and significantly improved swallowing ability in 71.9% of patients (p<0.01)12,13 as a solution to the nutritional needs of dysphagia patients post stroke 14 including intervention challenge swallow 90 cc of water. 15 The following intervention is laryngeal elevation exercises with techniques used: Tongue exercise, swallowing training, and speech therapy 16 ; Tongue Stretching that has a positive effect on tongue motility and oromotor function in post-stroke dysphagia patients 17 ; Tongue resistance can increase the strength of the tongue and reduce fluid residue in the vallecular 18 ; and Oral neuromuscular training.…”

Is an Oral Health Status a Predictor of Functional Improvement in Ischemic Stroke Patients Undergoing Comprehensive Rehabilitation Treatment?

“…Mostly, the modified Bass method was applied to the individuals as it is easy to learn, the most effective, and the most widely accepted technique of toothbrushing [ 51 ]. This method was also used by other dentists in stroke patients [ 52 ]. Needless to say that proper hygienic requirements concerning dentures were also given.…”