How Often Should A Stroke Patient Have A Dental Cleaning
Eur Stroke J. 2022 Dec; 3(iv): 347–354.
Oral care after stroke: Where are we at present?
Mary Lyons
1Faculty of Health and Wellbeing, University of Cardinal Lancashire, UK
2Section of International Public Health, Liverpool School of Tropical Medicine, U.k.
Craig Smith
3Division of Cardiovascular Sciences, Manchester Academic Wellness Science Center, University of Manchester, United kingdom of great britain and northern ireland
4Department of Neurosciences, Salford Royal NHS Foundation Trust, U.k.
Elizabeth Boaden
1Faculty of Health and Wellbeing, Academy of Fundamental Lancashire, U.k.
Marian C Brady
vNursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Great britain
Paul Brocklehurst
half-dozenNorth Wales Organisation for Randomised Trials in Health, Bangor Establish of Health and Medical Research and Salford Royal NHS Foundation Trust, Britain
Hazel Dickinson
1Kinesthesia of Health and Wellbeing, University of Central Lancashire, UK
Shaheen Hamdy
7Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Wellness, Academy of Manchester, UK
Susan Higham
eightInstitute of Psychology, Wellness and Social club, University of Liverpool, Great britain
Peter Langhorne
9Institute of Cardiovascular and Medical Sciences, Academy of Glasgow, Britain
Catherine Lightbody
1Faculty of Health and Wellbeing, University of Central Lancashire, Uk
Giles McCracken
tenCentre for Oral Health Inquiry, School of Dental Sciences, Newcastle University, UK
Antonieta Medina-Lara
11Wellness Economics Group, Medical School, University of Exeter, UK
Lise Sproson
12National Institute for Health Research Devices for Dignity Healthcare Technology Cooperative, Sheffield Didactics Hospitals NHS Foundation Trust, U.k.
Angus Walls
13Edinburgh Dental Establish, Higher of Medicine and Veterinary Medicine, University of Edinburgh, Britain
Dame Caroline Watkins
1Faculty of Wellness and Wellbeing, University of Central Lancashire, UK
14Faculty of Health Sciences, Australian Cosmic University, Australia
Received 2022 Dec 3; Accepted 2022 Apr 12.
- Supplementary Materials
-
Appendix 1 -Supplemental cloth for Oral care afterwards stroke: Where are we now?
GUID: 3F3DD0C1-D70F-405F-AD3D-DCDC84F7CFB6
Supplemental cloth, Appendix 1 for Oral care afterward stroke: Where are we now? by Mary Lyons, Craig Smith, Elizabeth Boaden, Marian C Brady, Paul Brocklehurst, Hazel Dickinson, Shaheen Hamdy, Susan Higham, Peter Langhorne, Catherine Lightbody, Giles McCracken, Antonieta Medina-Lara, Lise Sproson, Angus Walls and Dame Caroline Watkins in European Stroke Journal
Short abstract
Purpose
At that place appears to be an association between poor oral hygiene and increased risk of aspiration pneumonia – a leading cause of mortality mail-stroke. We aim to synthesise what is known most oral care after stroke, place knowledge gaps and outline priorities for research that will provide evidence to inform best practise.
Methods
A narrative review from a multidisciplinary perspective, drawing on evidence from systematic reviews, literature, practiced and lay opinion to scrutinise current exercise in oral care after a stroke and seek consensus on inquiry 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 surroundings where other aspects of clinical intendance take priority. Guidelines that exist are based on weak evidence and lack detail about how all-time to provide oral intendance.
Discussion
Oral wellness later a stroke is important from a social every bit well as physical wellness perspective, yet tends to be neglected. Multidisciplinary research is needed to meliorate understanding of the complexities associated with delivering good oral care for stroke patients. Also to provide the evidence for practice that volition amend wellbeing and may reduce hazard of aspiration pneumonia and other serious sequelae.
Decision
Although there is evidence of an association, there is just weak evidence about whether improving oral care reduces gamble of pneumonia or mortality after a stroke. Clinically relevant, feasible, cost-effective, testify-based oral care interventions to better patient outcomes in stroke care are urgently needed.
Keywords: Stroke, oral wellness, oral hygiene, oral cavity, mouth, dental, pneumonia, quality of life, tooth-brushing
Introduction
Poor oral intendance after a stroke tin can accept serious physical, psychological and social consequences and adversely affect quality of life.1–3
Aspiration pneumonia causes the highest attributable mortality of all medical complications following stroke and its prevention is therefore of paramount importance.4,5 At that place is a growing body of evidence to indicate that poor oral hygiene increases the hazard of pneumonia.6,7 It would be rational to expect good oral hygiene and plaque control in the early stages after a stroke to reduce risk, but evidence for this is weak.eight–10
Dysphagia and loss of sensation affects upward to 78% of patients who have recently had a stroke and can cause stasis of saliva and nutrient in the oral cavity.xi–13 Reduced tongue pressure level and contradistinct lateral movements outcome in increased risk of aspiration as well equally causing food to puddle in the sulci of the oral cavity resulting in denture problems and stomatitis.fourteen–16 There also appears to exist a college than normal pathogenic bacterial and yeast count in the oral cavity in the astute phase of stroke.17,xviii This combination increases the run a risk of aspiration pneumonia.9,19–24 Approximately ten,000 microbial phylotypes take been identified in the human being oral microflora.25 There is a huge diversity of bacterial organisms in the oral cavity of stroke patients. The rest betwixt organisms may be equally important for containing risk of aspiration pneumonia as the presence or the absence of any detail bacteria in the oral cavity.26
Whilst stroke tin can touch on people of all ages, the average is 71 years.27 In many depression and middle-income countries, the incidence of stroke is increasing merely even in many European countries where information technology is decreasing, the size of the problem, based on the bodily number of new strokes is rising because of the ageing population.27 Effigy 1 shows the improving pattern of dentition between 1978 and 2009 in England. Although considerably more people are surviving into old age with some natural teeth, very few have excellent oral health. Most have periodontal disease, a sizeable number of restorations (fillings and implants) and need aid to maintain their oral health.28,29
Trends in percentage of adults with 21 or more natural teeth by age, England 1978–2009.
Source: Oral health and role – a report from the developed dental wellness survey 2009. NHS Information centre for health and social intendance. Copyright© 2022, Re-used with the permission of the Health and Social Care Information Centre, besides known as NHS Digital. All rights reserved.
The cost of dental care in the European Union is expected to rising from €54 billion in 2000 to €93 billion in 2022.30 A significant proportion of this relates to the provision of oral intendance for the growing number of dependent older people – including those who take had a stroke.31,32
People who have a stroke tend to accept worse oral health than the rest of the population just a cause and effect relationship cannot be causeless and the relative importance of specific risk factors such equally smoking, poor nutrition and diabetes that stroke and poor oral health have in common is unclear.33 A scoping review of oral care post stroke found that stroke survivors aged 50 to 70 years have fewer natural teeth and are more likely to wear dentures than a control group of a similar age who had not had a stroke.19,34 A systematic review found that patients with stroke had a poorer clinical oral health status across a range of parameters (molar loss, dental caries experience and periodontal status).20 Other reviews have demonstrated an association betwixt periodontal disease and stroke.33,35
What is to follow
In this newspaper, we review the latest research on oral health in people who have had a stroke and the care dilemmas this creates. Nosotros reverberate on what people who have had a stroke and their carers think most the oral care patients receive and investigate the challenges of its provision in this population. We place gaps in cognition about optimum oral treat stroke patients and areas where further research is needed to provide the evidence to back up best practice.
Method
This is a narrative review, based on findings from systematic reviews, primary enquiry, other published literature combined with expert and lay opinion. Information technology provides a holistic interpretation of the current situation in relation to oral intendance in stroke patients.
Consensus on knowledge gaps for optimum oral intendance and research priorities was reached after a serial of discussions with stroke survivors, carers, clinical and bookish experts in dental care, health economics, concrete medicine, oral communication and linguistic communication therapy, medical imaging, public health and nursing. It takes account of the pluralities and diversities of the disciplines involved. An iterative process to synthesise the chief issues and their implications, identify gaps and directions for hereafter research was undertaken through a serial of meetings and discussions. The manuscript was drafted and revised by all authors.
Findings
A prompt oral examination and assessment in patients who have had a stroke is of import because it determines oral hygiene needs, informs an oral care programme and identifies problems that may bear on recovery.36 Bachelor oral assessment protocols score features such as saliva, soft tissues and scent; with dental plaque, oral function, swallowing, voice quality and hard tissue assessment suggested in some. However, few oral assessment tools exist, and those that do, are not specifically developed for, or validated in patients with stroke and are rarely used.nineteen,37 Nurses are best placed to conduct the initial oral cess and can also be trained to place patients who may need referral to a dental specialist.38
Dependent stroke survivors rely on nursing staff to assistance them, simply without bear witness based pathways, adequate knowledge, skills, confidence and support from senior staff and dental professionals, nurses cannot provide effective, expert quality oral care.
Hospitalisation, reduced nutrient and drink intake, increased exposure to antibiotics and dependency can affect stroke patients' ability to maintain oral hygiene effectively.14,19 Dehydration and xerostomia can be a particular problem because of oxygen therapy, mouth animate, side-effects of medications and reduced nutrient and fluid intake.39,40 In these circumstances, oral intendance tin can exist challenging and is often given depression priority by nurses.41
Oral care tin be further complicated where swallow safety is compromised, as patients may be unable to go along any nutrient residuum, toothpaste or rinsing fluids from inbound their airway.
In that location is currently neither show nor consensus guidance for best exercise in assessment of need, equipment, procedure or how frequently oral care should exist provided. Practise in different locations varies widely and staff feel insufficiently trained to deliver oral care effectively.19,42–44 The current lack of appropriate training and failure to prioritise oral care within the stroke care pathway has the biggest impact on patients with greatest need who are at high risk of complications.10
Patient, carer and professionals' perspectives
For those who survive a stroke, life often changes dramatically equally they and their families learn to live with the disabling consequences such as paralysis, muscle weakness, cerebral impairment, fatigue, feet and depression.45,46 Stroke patients oft experience oral discomfort and pain, oral infections (especially oral candidiasis) and difficulties in denture wearing.2,3,fourteen,47 Normal daily activities that affect oral hygiene such as eating, drinking and tooth brushing can exist severely disrupted.48
Tabular array i summarises findings from studies exploring stroke patients, carers and professionals experience of oral intendance. Barriers such as fearfulness of perhaps causing harm, lack of knowledge, skill or ability, lack of time, low priority, inadequate resources and lack of guidance are the main explanations provided by carers and professionals for inadequate oral care provision in stroke patients.1,49–51
Table ane.
Key points.
| • Oral intendance is perceived every bit of import past patients, carers and professionals.52,53 |
| • Patients experience broken-hearted and distressed nigh their appearance and worry that they may have halitosis.ii,53 |
| • Lack of intendance is common and is a cause of distress for patients and their families.52,54 |
| • Nurses make assumptions virtually patients' ability to attend to their ain oral care, and patients observe information technology difficult to enquire for what they need.42,53 |
| • Relatives and friends express empathy but feel powerless to intervene and provide the intendance themselves.42,53 |
| • Bones materials needed to provide good oral care are frequently unavailable in stroke units.44 |
| • There is dubiousness and fearfulness about the best way to provide oral care for stroke patients.51,53 |
Evidence
There are few evidence-based cess tools, guidelines and protocols for oral intendance in the stroke population.19,55,56 A Cochrane systematic review on staff-led interventions for improving oral hygiene following a stroke was updated in 2022.one The review included three trials. Gosney et al.57 found high carriage of and colonisation by aerobic Gram-negative leaner in stroke patients. In this randomised controlled trial, the use of an oral decontaminating gel reduced the presence of leaner and documented episodes of pneumonia, but mortality remained unchanged. Frenkel et al.58 establish that didactics can meliorate caregivers' noesis, attitudes and oral care performance. Fields59 found that the ventilator associated pneumonia rate in an intensive care unit of measurement that included, merely was non specific to, stroke patients dropped to zero in the intervention grouping within a week of outset a tooth-brushing government. Later on half-dozen months, the control group was dropped, and all intubated patients' teeth were brushed every 8 hours, maintaining a zero rate of ventilator-associated pneumonia until the end of the 2-year study. Lack of acceptable data meant that the findings were not included in the meta-assay.
The Cochrane review ended that provision of preparation in oral care interventions can ameliorate staff cognition and attitudes, cleanliness of patients' dentures and reduce incidence of pneumonia. However, bear witness was weak and improvements in the cleanliness of patients' teeth were not observed. Table 2 provides an overview of the relevant research published on oral care in stroke patients since the 2022 Cochrane review update.
Table 2.
Recent oral care research.
| Author | Design | Study | Key findings |
|---|---|---|---|
| Smith et al., 202260 | Mixed methods feasibility written report (29 patients, x staff) | Staff teaching and training, and twice-daily brushing with chlorhexidine gel (or non-foaming toothpaste) and denture intendance if required. | Interventions were feasible, acceptable and raised knowledge and awareness. |
| Wagner et al, 202210 | Quasi-experimental, n= 1656 (949 in the intervention group 707 controls) | To compare the proportion of pneumonia cases in hospitalised stroke patients before and later on implementation of an oral health intendance intervention in the United States. | Systematic oral health care was associated with decreased odds of hospital-acquired pneumonia. |
| Kuo et al, 202261 | Randomised controlled trial (RCT), n=94 (48 in intervention group, 46 controls) | To evaluate the effectiveness of a home-based oral intendance grooming programme for stroke survivors in Taiwan. | Poor oral hygiene and fail of oral care was observed at baseline.The intervention group had significantly lower tongue coating and dental plaque than the control grouping.There was no difference in symptoms of respiratory infection between the groups. |
| Dai et al, 2022xx | Systematic review of observational studies | Studies exploring oral health outcomes and oral-health-related behaviours in stroke patients. | Patients with stroke had poorer oral health than healthy controls, and prior to the stroke tended to be less frequent dental intendance attenders. |
| Horne et al, 202242 | Qualitative study. Two focus groups (n=ten) | Explored experiences and perceptions about the barriers to providing oral care in stroke units in Greater Manchester (Great britain). | Lack of understanding of the importance of oral care, inconsistent exercise, lack of equipment and inadequate training for staff and carers. |
| Juthani-Mehta et al, 202262 | Non stroke-specific cluster RCT, n=834 (434 intervention, 400 control) | Transmission tooth/gum brushing plus 0.12% chlorhexidine oral rinse delivered twice a solar day and upright feeding position was compared to usual care in nursing homes in the United States. | Fewer cases of pneumonia in the intervention group, the difference was not statistically significant. |
| Chipps et al, 20228 | Randomised controlled pilot study, northward=51 (29 intervention, 22 command) | A standardised oral intendance intervention performed twice a solar day was compared to usual care in a stroke rehabilitation setting in the United States. | Subjects in both groups showed comeback in their oral health assessments, swallowing and oral intake over fourth dimension, but the difference was not statistically significant.Staphylococcus aureus colonisation in the control group nigh doubled (from 4.8% to 9.v%), while colonisation in the intervention group decreased (from 20.8% to sixteen.7%) but again differences were not statistically significant. |
| Kim et al, 202247 | RCT n=56 (29 intervention, 29 control) | Impact of an oral care programme delivered to patients who had recently experienced their first stroke in the intensive care unit of measurement of a university hospital in Korea. | Plaque index, gingival index and presence of candida in the saliva were significantly lower in the intervention compared to the control group. There was no significant difference betwixt the groups in clinical zipper, tooth loss or presence of Candida albicans on the tongue. |
| Seguin et al, 202263 | RCT, n=179 (91 intervention, 88 control) | A non-stroke-specific trial conducted in six intensive care units in France. The intervention consisted of washing the oropharyngeal cavity with diluted povidone-iodine or placebo. | No evidence to recommend oral care with povidone-iodine to prevent ventilator-associated pneumonia in high-chance patients. The use of povidone-iodine seemed to increment the gamble of astute respiratory distress syndrome. |
| Lam et al, 202264 | RCT, north = 102 (33 in group 1, 34 in group 2, 35 in group 3) | Three groups in a stroke rehabilitation ward in Hong Kong were provided with an electric toothbrush and standard fluoride toothpaste. Group one received oral hygiene instruction only, grouping ii received this plus chlorhexidine mouthwash and group three received the same as two, plus assistance with brushing twice a calendar week. | Poor oral hygiene was noted in all groups at baseline. Significant reductions in dental plaque and gingival bleeding were noted in both intervention groups 2 and iii compared to group 1. The affect on pneumonia could not be ascertained as no cases were recorded. |
| Lam et al, 202265 | Literature review | A review of not-stroke-specific studies that evaluated the effectiveness of oral hygiene interventions in reducing oropharyngeal carriage of aerobic and facultatively anaerobic gram-negative bacilli (AGNB) in medically compromised patients. | The effects of antiseptic agents could not be discerned from the adjunctive mechanical oral hygiene measures. High-quality RCTs are needed to make up one's mind which combinations of oral hygiene interventions are most constructive in eliminating or reducing AGNB railroad vehicle. |
Discussion
Adequate oral care improves patients' oral health, comfort and quality of life, but definitive evidence of its ability to reduce the risk of pneumonia is lacking.55 2 non-stroke specific nursing home based studies, i from Japan (2002) and the second from the The states (2008) evaluated the impact of an oral care intervention in a setting where there were a number of stroke patients.6,66 Both studies reported fewer cases of pneumonia (or related death) amongst residents that received oral health care simply the Japanese trial excluded incapacitated, dysphagic, unstable and unconscious residents.vi Unfortunately, in many trials the challenges associated with gaining informed consent result in patients who are most dependent for oral care being excluded.
Several guidelines refer to oral care following a stroke (See Supplementary Appendix 1 which volition be available online with this article, http://journals.sagepub.com/doi/full/10.1177/2396987318775206). Many refer to the lack of evidence to support detailed guidance. Answers to bones questions about whether it is best to employ an electric or manual toothbrush, size and type of head, which – if whatsoever toothpaste, how oftentimes care should be given, etc. are non provided. No guidelines contain information or advice to convalesce nurses' anxieties about how best to reduce risk of choking when delivering oral care for dysphagic stroke patients.
Information technology is a limitation of this report that there is little evidence about oral care practice in stroke units across Europe, hence most of the included studies are from elsewhere.
Hereafter considerations
Emerging prove supports the rationale for developing best do guidelines for oral care in stroke care units.19 High-quality evidence is needed to inform improvements in staff preparation and delivery of consistent oral care. Protocols need to be developed that focus on maintenance of dentition and a quality of life associated with having acceptable oral function. Protocols need to depict simple preventative measures at every stage in the care pathway, combined with early diagnosis and management of meaning dental pathology. Several oral hygiene interventions appear to be feasible and well-tolerated in early-stage studies.47,55,59,60,63,64
Research is needed to inform the spectrum and variation in existing 'usual' care and service provision (including the office of specialist dental services) as well every bit optimal oral assessment tool(due south), including for patients who are intubated also every bit afterwards during the rehabilitation phase.
Safety, acceptability and resources required to evangelize high-quality oral care assessments and protocols needs to exist established.
Clarity is needed about the multi-disciplinary squad support required, especially around optimisation of effective staff education and training, including from dental specialists.
Ultimately, big phase three randomised trials supported past realistic recruitment and clinically relevant strategies, economical evaluation and implementation strategies are required. They need to produce practical clinical outcomes that accost barriers and facilitators to change and adoption of show into policy and practice.
Priority should be given to research that provides testify to inform standards for oral intendance delivery, and guidelines for each patient with individualised care plans that illustrate the safest, almost efficient equipment to use.
Conclusions
There is a lack of noesis nearly how and what oral intendance is currently provided likewise every bit inadequate research to inform best practice in acute stroke care, rehabilitation and nursing habitation settings.
Staff feel inadequately prepared to provide oral care, peculiarly when dysphagia or other problems are present and it tends to be given low priority. This review provides an objective platform to encourage health and care services to comprise oral intendance into time to come stroke pathways, whilst stimulating greater engagement with this nether-researched expanse.
Supplemental Textile
Appendix 1 -Supplemental material for Oral care afterward stroke: Where are nosotros now?
Supplemental material, Appendix 1 for Oral care afterwards stroke: Where are we at present? by Mary Lyons, Craig Smith, Elizabeth Boaden, Marian C Brady, Paul Brocklehurst, Hazel Dickinson, Shaheen Hamdy, Susan Higham, Peter Langhorne, Catherine Lightbody, Giles McCracken, Antonieta Medina-Lara, Lise Sproson, Angus Walls and Dame Caroline Watkins in European Stroke Periodical
Acknowledgements
Mary Harrington, Head of Speech & Linguistic communication Therapy, Hull & East Yorkshire Hospitals NHS Trust reviewed and commented on the paper.
Proclamation of Conflicting Interests
The author(s) declared no potential conflicts of involvement with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following fiscal back up for the enquiry, authorship, and/or publication of this article: This work was supported by a NIHR CRN/British Association of Stroke Physicians stroke writing group grant.
Informed consent
Not applicative as this is a review commodity.
Ethical approving
Non applicable equally this is a review article and contains no primary inquiry.
Contributorship
CW and CS devised the conceptual framework. CS, EB, MCB, HD, ShH, SH, ML and GMcC contributed sections to this paper. ML synthesised contributions with back up from PL, CL, AM-L, LP, AW and CW. All authors reviewed, edited and approved the final version of the paper.
References
1. Brady MC, Furlanetto D, Hunter R, et al. Staff-led interventions for improving oral hygiene in patients post-obit stroke. Cochrane Database of Syst Rev 2006. (Updated 2022). [PubMed] [Google Scholar]
2. Schimmel M, Leemann B, Christou P, et al. Oral health-related quality of life in hospitalised stroke patients. Gerodontology 2022; 28: iii–11. [PubMed] [Google Scholar]
3. Locker D, Clarke One thousand and, Payne B. Self-perceived oral health status, psychological well-existence, and life satisfaction in an older adult population. J Dent Res 2000; 79: 970–975. [PubMed] [Google Scholar]
4. Langhorne P, Stott D, Robertson Fifty, et al. Medical complications after stroke a multicenter report. Stroke 2000; 31: 1223–1229. [PubMed] [Google Scholar]
5. Katzan IL, Cebul RD, Husak SH, et al. The result of pneumonia on mortality among patients hospitalized for acute stroke. Neurology 2003; 60: 620–625. [PubMed] [Google Scholar]
six. Yoneyama T, Yoshida M, Ohrui T, et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 2002; 50: 430. [PubMed] [Google Scholar]
7. Sjogren P, Nilsson E, Forsell G, et al. A systematic review of the preventive upshot of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: Upshot estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc 2008; 56: 2124–2130. [PubMed] [Google Scholar]
8. Chipps E, Gatens C, Genter L, et al. Pilot study of an oral care protocol on poststroke survivors. Rehabil Nurs 2022; 39: 294–304. [PubMed] [Google Scholar]
9. Sorensen RT, Rasmussen RS, Overgaard Chiliad, et al. Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke. J Neurosci Nurs 2022; 45: 139–146. [PubMed] [Google Scholar]
ten. Wagner C, Marchina Due south, Deveau JA, et al. Risk of stroke-associated pneumonia and oral hygiene. Cerebrovasc Dis) 2022; 41: 35–39. [PubMed] [Google Scholar]
12. Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications. Stroke 2005; 36: 2756–2763. [PubMed] [Google Scholar]
13. Teismann IK, Steinstraeter O, Stoeckigt K, et al. Functional oropharyngeal sensory disruption interferes with the cortical control of swallowing. BMC Neurosci 2007; 8: 62. [PMC free commodity] [PubMed] [Google Scholar]
14. Hunter RV, Clarkson JE, Fraser HW, et al. A preliminary investigation into molar care, dental attendance and oral health related quality of life in adult stroke survivors in Tayside, Scotland. Gerodontology 2006; 23: 140–148. [PubMed] [Google Scholar]
15. Hori M, Ono T, Iwata H, et al. Tongue pressure against hard palate during swallowing in mail-stroke patients. Gerodontology 2005; 22: 227–233. [PubMed] [Google Scholar]
16. Kim IS and, Han TR. Influence of mastication and salivation on swallowing in stroke patients. Arch Phys Med Rehabil 2005; 86: 1986–1990. [PubMed] [Google Scholar]
17. Zhu HW, McMillan As, McGrath C, et al. Oral carriage of yeasts and coliforms in stroke sufferers: A prospective longitudinal study. Oral Dis 2008; xiv: threescore. [PubMed] [Google Scholar]
eighteen. Millns B, Gosney M, Jack C, et al. Astute stroke predisposes to oral gram-negative bacilli–a cause of aspiration pneumonia?. Gerontology 2003; 49: 173–176. [PubMed] [Google Scholar]
xix. Kwok C, McIntyre A, Janzen S, et al. Oral care mail stroke: A scoping review. J Oral Rehabil 2022; 42: 65–74. [PubMed] [Google Scholar]
20. Dai R, Lam OL, Lo EC, et al. A systematic review and meta-assay of clinical, microbiological, and behavioural aspects of oral health among patients with stroke. J Dent 2022; 43: 171–180. [PubMed] [Google Scholar]
21. Lafon A, Pereira B, Dufour T, et al. Periodontal disease and stroke: A meta-analysis of cohort studies. Eur J Neurol 2022; 21: 1155–1161, e66–67. [PubMed] [Google Scholar]
22. Lam OL, McMillan AS, Li LS, et al. Oral health and post-discharge complications in stroke survivors. J Oral Rehabil 2022; 43: 238–240. [PubMed] [Google Scholar]
23. Azarpazhooh A, Leake JL. Systematic review of the association betwixt respiratory diseases and oral health. J Periodontol 2006; 77: 1465–1482. [PubMed] [Google Scholar]
24. Scannapieco FA, Bush-league RB, Paju S. Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary illness. A systematic review. Ann Periodontol 2003; 8: 54–69. [PubMed] [Google Scholar]
25. Keijser B, Zaura Due east, Huse Due south, et al. Pyrosequencing assay of the oral microflora of healthy adults. J Dent Res 2008; 87: 1016–1020. [PubMed] [Google Scholar]
26. Boaden Due east, Lyons M, Singhrao SK, et al. Oral flora in acute stroke patients: A prospective exploratory observational written report. Gerodontology 2022; 34: 343–356. [PubMed] [Google Scholar]
27. Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990–2010: Findings from the Global Burden of Disease Report 2022. Lancet 2022; 383: 245–254. [PMC complimentary commodity] [PubMed] [Google Scholar]
28. Office for National Statistics Social Survey Division Data Heart for Health and Social Intendance. Developed Dental Wellness Survey, 2009. 2d ed. In: United kingdom Information Service. SN: 6884, 2022.
29. Derks J, Tomasi C. Peri-implant health and illness. A systematic review of electric current epidemiology. J Clin Periodontol 2022; 42: S158–S171. [PubMed] [Google Scholar]
thirty. Widsträm E, Eaton KA. Oral healthcare systems in the extended European Marriage. Oral Health Prev Dent 2004; two: 155. [PubMed] [Google Scholar]
31. Glick Chiliad, Monteiro da Silva O, Seeberger GK, et al. FDI Vision 2022: Shaping the time to come of oral wellness. Int Dent J 2022; 62: 278–291. [PubMed] [Google Scholar]
32. Andersson P, Renvert S, Sjogren P, et al. Dental condition in nursing habitation residents with domicilic dental intendance in Sweden. Commun Dent Health 2022; 34: 203–207. [PubMed] [Google Scholar]
33. Pickett FA. State of evidence: Chronic periodontal illness and stroke. Tin can J Paring Hygiene 2022; 46. [Google Scholar]
34. Yoshida M, Murakami T, Yoshimura O, et al. The evaluation of oral wellness in stroke patients. Gerodontology 2022; 29: e489–e493. [PubMed] [Google Scholar]
35. Leira Y, Seoane J, Blanco M, et al. Association between periodontitis and ischemic stroke: A systematic review and meta-analysis. Eur J Epidemiol 2022; 32: 43–53. [PubMed] [Google Scholar]
36. Intercollegiate Stroke Working Political party. National clinical guideline for stroke 5th ed. London: Royal College of Physicians, 2022.
37. Abidia RF. Oral care in the intensive care unit of measurement: A review. J Contemp Dent Pract 2007; 8: 76–82. [PubMed] [Google Scholar]
38. Jones H. Oral care in intensive care units: A literature review. Spec Care Dentist 2005; 25: 6–11. [PubMed] [Google Scholar]
39. Kerr GD, Sellars C, Bowie L, et al. Xerostomia after acute stroke. Cerebrovasc Dis 2009; 28: 624. [PubMed] [Google Scholar]
40. Bahouth MN, Hillis A and, Gottesman R. A prospective study of the result of dehydration on stroke severity and short term outcome. Stroke 2022; 46(1S). [Google Scholar]
41. Costello T and, Coyne I. Nurses' knowledge of oral fissure intendance practices. Br J Nurs 2008; 17: 2648. [PubMed] [Google Scholar]
42. Horne Grand, McCracken G, Walls A, et al. Organisation, practice and experiences of mouth hygiene in stroke unit of measurement care: A mixed-methods study. J Clin Nurs 2022; 24: 728–738. [PubMed] [Google Scholar]
43. Willumsen T, Karlsen L, Næss R, et al. Are the barriers to skilful oral hygiene in nursing homes within the nurses or the patients? Gerodontology 2022; 29: e748e–e755. [PubMed] [Google Scholar]
44. Talbot A, Brady M, Furlanetto DL, et al. Oral care and stroke units. Gerodontology 2005; 22: 77–83. [PubMed] [Google Scholar]
45. Luengo-Fernandez R, Paul NLM, Gray AM, et al. Population-based written report of disability and institutionalization after transient ischemic attack and stroke: 10-year results of the Oxford Vascular Written report. Stroke 2022; 44: 2854–2861. [PMC free article] [PubMed] [Google Scholar]
46. Crichton SL, Bray BD, McKevitt C, et al. Patient outcomes upwardly to fifteen years after stroke: Survival, disability, quality of life, cognition and mental health. J Neurol Neurosurg Psychiatry 2022; 87: 1091–1098. [PubMed] [Google Scholar]
47. Kim E-K, Jang S-H, Choi Y-H, et al. Effect of an oral hygienic intendance plan for stroke patients in the intensive intendance unit of measurement. Yonsei Med J 2022; 55: 240–246. [PMC free article] [PubMed] [Google Scholar]
48. Terezakis E, Needleman I, Kumar N, et al. The affect of hospitalization on oral health: A systematic review. J Clin Periodontol 2022; 38: 628–636. [PubMed] [Google Scholar]
49. Wårdh I, Hallberg LRM, Berggren U, et al. Oral health intendance—a low priority in nursing. Scand J Caring Sci 2000; fourteen: 137–142. [PubMed] [Google Scholar]
50. Adams R. Qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards. J Adv Nurs 1996; 24: 552–560. [PubMed] [Google Scholar]
51. Brady MC and, Furlanetto D. Oral health care following stroke - a review of assessments and protocols. Clin Rehab 2009; 23: 7565–7763. [Google Scholar]
52. Salamone K, Yacoub E, Mahoney A-K, et al. Oral care of hospitalised older patients in the astute medical setting. Nurs Res Pract 2022; 2013: 4. [PMC complimentary article] [PubMed] [Google Scholar]
53. Dickinson H. Improving the evidence base for oral assessment in stroke patients. Unpublished PhD Thesis, University of Central Lancashire, UK, 2022.
54. Health Instruction England. Rima oris Care Matters. 2022.
55. Brady MC, Stott DJ, Norrie J, et al. Developing and evaluating the implementation of a complex intervention: Using mixed methods to inform the design of a randomised controlled trial of an oral healthcare intervention after stroke. Trials 2022; 12: xiv. [PMC free article] [PubMed] [Google Scholar]
56. Karki AJ, Monaghan N, Morgan M. Oral health condition of older people living in care homes in Wales. Br Dent J 2022; 219: 331–334. [PubMed] [Google Scholar]
57. Gosney G, Martin MV, Wright AE. The function of selective decontamination of the digestive tract in acute stroke. Age Ageing 2006; 35: 42–47. [PubMed] [Google Scholar]
58. Frenkel HF, Harvey I, Newcombe RG. Improving oral health of institutionalised elderly people by educating caregivers: A randomised controlled trial. Commun Dent Oral Epidemiol 2001; 29: 289–297. [PubMed] [Google Scholar]
59. Fields LB. Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit. J Neurosci Nurs 2008; 40: 291–298. [PubMed] [Google Scholar]
60. Smith CJ, Horne Yard, McCracken 1000, et al. Development and feasibility testing of an oral hygiene intervention for stroke unit of measurement intendance. Gerodontology 2022; 34: 110–120. [PubMed] [Google Scholar]
61. Kuo YW, Yen M, Fetzer S, et al. Event of family unit caregiver oral intendance training on stroke survivor oral and respiratory health in Taiwan: A randomised controlled trial. Commun Dent Health 2022; 32: 137–142. [PubMed] [Google Scholar]
62. Juthani-Mehta M, Van Ness PH, McGloin J, et al. A cluster-randomized controlled trial of a multicomponent intervention protocol for pneumonia prevention among nursing home elders. Clin Infect Dis 2022; threescore: 849–857. [PMC free commodity] [PubMed] [Google Scholar]
63. Seguin P, Laviolle B, Dahyot-Fizelier C, et al. Effect of oropharyngeal povidone-iodine preventive oral care on ventilator-associated pneumonia in severely brain-injured or cerebral hemorrhage patients: A multicenter, randomized controlled trial. Crit Care Med 2022; 42: 1–8. [PubMed] [Google Scholar]
64. Lam OL, McMillan AS, Samaranayake LP, et al. Randomized clinical trial of oral health promotion interventions among patients following stroke. Arch Phys Med Rehabil 2022; 94: 435–443. [PubMed] [Google Scholar]
65. Lam OL, McGrath C, Li LS, et al. Effectiveness of oral hygiene interventions against oral and oropharyngeal reservoirs of aerobic and facultatively anaerobic gram-negative bacilli. Am J Infect Control 2022; forty: 175–182. [PubMed] [Google Scholar]
66. Bassim CW, Gibson G, Ward T, et al. Modification of the risk of mortality from pneumonia with oral hygiene care. J Am Geriatr Soc 2008; 56: 1601–1607. [PubMed] [Google Scholar]
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571511/
Posted by: weldonhatiou.blogspot.com
0 Response to "How Often Should A Stroke Patient Have A Dental Cleaning"
Post a Comment