Integrated oral health care for stroke patients – a scoping review

Aims and objectives: To identify current evidence on the role of nurses and allied health professionals in the oral health management of stroke patients, detailing their current knowledge, attitudes and practices and the potential benefits of an integrated oral care programme. Background: Stroke has disabling oral health effects, such as dysphagia and hindered brushing due to upper limb hemiparesis. Together, these can increase bacterial load, increasing risk of pneumonia. In general management of stroke, nurses play a key role in early identification, assessment and referral, while occupational therapists, dieticians and speech pathologists are important in rehabilitation. While this should logically apply to the oral care of stroke patients, there is currently limited information, especially in Australia. Design: Scoping review. Method: A literature search was conducted using multiple databases regarding the oral health management of stroke patients by nondental professionals, and 26 articles were reviewed. Results: The Australian National Clinical Guidelines for Stroke accentuate the need for oral care following stroke and suggest how hospital staff need to be involved. Currently, there are no Australian studies. However, international literature suggests that lack of oral health knowledge by nurses and poor patient attitude are reflected in infrequent assistance with stroke patient oral hygiene. There is limited information regarding the benefits of nursing-driven oral hygiene programme in reducing pneumonia incidence, and only few studies show that involving nurses in assisted oral care reduces plaque. There are some suggestions that involving nurses and speech pathologists in oral rehabilitation can improve dysphagia outcomes. Conclusion: Managing oral health poststroke is vital, and there is a need for an appropriate integrated oral care service in Australia. Relevance to clinical practice: Nondental professionals, especially nurses, can play a key role in the poststroke oral health management of stroke patients to reduce complications, especially pneumonia

Integrated oral care for stroke patients

Background and Rationale: Stroke has disabling oral health (OH) effects, such as dysphagia and hindered brushing due to upper limb hemiparesis. Together, these can increase bacterial load, leading to pneumonia (Kwok et al, 2015). Since the National Clinical Guidelines (National Stroke Foundation, 2010) mention the need for post-stroke oral care, this review aims to identify OH attitudes and practices of nursing and allied health professionals and the benefits of integrating them into a post-stroke oral care program. Methods: A literature search was conducted using multiple databases (MEDLINE, EMBASE etc.) and combinations of medical, nursing and AH staff and OH terms were searched. Results: Currently, no studies have been conducted in Australia. However, studies in Malaysia suggest that nurses have inadequate oral health knowledge, reflected in their infrequent assistance with stroke patient brushing and mouthwash (Malik et al, 2015). There is limited information regarding the benefits of an integrated oral care program, with only a couple of trials indicating that involving nurses in assisted oral care can reduce plaque score (Lam et al, 2013), and reduce NPO status and stroke patient length of stay (Talley et al, 2015). Another questionnaire study suggests that involving nurses and speech pathologists in oral rehabilitation can improve dysphagia outcomes (Zheng et al, 2014). Conclusion: This scoping review highlights the need for further studies to be conducted, especially in Australia, to assess the role of non-dental professionals in an integrated oral care program for stroke patients. The debilitating oral health effects of stroke make future studies vital, potentially leading to a pathway between non-dental staff and oral health professionals, improving overall stroke outcomes