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.