Oral Care Assessment Tools and Interventions After Stroke.

Abstract

Oral hygiene assessment and oral care are critical—but often overlooked—nursing interventions after a stroke. In this review, we describe the oral biofilm, threats to oral health, current oral assessment tools, and oral hygiene programs for patients who have had a stroke. In healthy individuals, the oral microbiota is predominantly Gram-positive and is sometimes characterized as the human oral microbiome database. Patients diagnosed with periodontal disease have a Gram-negative microbiome, which is associated with inflammation and infection.1 Dental plaque is composed of thick bacterial cell layers around the tooth surface. Frequently called a biofilm, this plaque thickens in individuals with poor oral hygiene.2 Because the tooth surface is uniquely defined by its nonshedding characteristics, the teeth may harbor organisms that lead to the development of a thick biofilm, a known precursor to periodontitis. Periodontitis is implicated as contributing to the worsening of systemic diseases, such as cardiovascular disease.3 Tonomura et al4 reported an association with deep cerebral microhemorrhages and intracerebral hemorrhages in patients with certain strains of a common oral pathogen, Streptococcus mutans , which harbors the CNM gene. Patients with preexisting periodontal disease who have had a stroke and have experienced dysphagia are at increased risk for translocation of pathogenic oral microbes to the lungs. DNA genomic analyses of dental plaque samples have shown that the genetic material from bronchial samples of patients in the intensive care unit with ventilator-associated pneumonia are identical,5 further underscoring the importance of oral hygiene. In 2003, Scannapieco et al6 performed a systematic review of 21 studies of periodontal disease and found a significant association between pneumonia and dental plaque or dependency for oral care. Frequent cleaning of the tooth’s surface may provide the necessary desquamative effects for decreasing the microbial burden of such pathogens.7 In people for …