A systematic review and meta-analysis of clinical, microbiological, and behavioural aspects of oral health among patients with stroke

Objective: The objective of this study was to review clinical, microbiological, and immunological aspects of oral health, as well as oral health related behaviours among patients following stroke. Data sources: A structured search strategy was applied to three electronic databases to identify relevant papers. Study selection: The initial search yielded 19,927 papers, 60 potentially relevant studies (Kappa: 0.974) and 23 relevant papers (Kappa: 0.965) in accordance with the inclusion criteria. Outcomes regarding tooth condition, periodontal condition, oral hygiene status, and dental attendance were pooled for seven meta-analyses. Narrative summaries were provided for those outcomes which could not be pooled for meta-analysis. Results: The standardized differences in mean values of the parameters (fixed effect, random effect model) for patients with stroke compared to control groups were: number of teeth (-0.325, -0.271), DMFT (0.246, 0.246), oral hygiene status -plaque index (0.305, 0.356) and gingival index (0.716, 0.653), periodontal health status -clinical attachment loss (0.437, 0.490) and probing depth (0.470, 0.579). In addition, a lower chance of dental attendance was observed among patients with stroke(oddsratio: 0.493,0.480). For those outcomes which could not be pooled for meta-analysis, it was not possible to draw any qualitative conclusion due to the equivocal results of these studies. Conclusions: There is an increasing interest in oral health of patients with stroke. Patients with stroke had a poorer clinical oral health status across a range of parameters (tooth loss, dental caries experience, and periodontal status). Coupled with this, their dental attendance was less frequent. Further studies employing standardized assessments of oral health/oral health behaviour can confirm these oral health disparities. Clinical significance: With comprehensive literature search, this systematic review and meta-analysis indicated a poorer oral health status and less frequent dental attendance behaviour among patients with stroke. (C) 2014 Published by Elsevier Ltd.