Randomized Clinical Trial of Oral Health Promotion Interventions Among Patients Following Stroke

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 plague, 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 plague 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. Archives of Physical Medicine and Rehabilitation 2013;94:435-43 (C) 2013 by the American Congress of Rehabilitation Medicine