Abstract
In acute stroke patients, it is important to maintain tongue hygiene and tongue function for prognosis management. However, the direct relationship between these factors is unclear, since these are often assessed by multiple observables. In this study, we used structural equation modeling (SEM) analysis, a tool to analyze the relationship between concepts that cannot be measured directly, to analyze the relationship between tongue hygiene and tongue function. The subjects were 73 patients with acute stroke admitted to a university hospital who underwent dental intervention. Age, sex, nutritional intake method, clinical severity classification of dysphagia, number of current teeth, number of functional teeth, oral health, tongue movement, tongue coating, number of microorganisms on the tongue surface, tongue surface moisture level, and tongue pressure were measured at the first visit. SEM analysis showed that the relationship between tongue function and tongue hygiene was 0.05 between tongue function and swallowing function was 0.90, and that between tongue hygiene and swallowing function was 0.09. We found no statistical relationship between tongue function and tongue hygiene in acute stroke patients. However, it was reconfirmed that tongue function is strongly related to feeding and swallowing functions.
Highlights
Dysphagia is associated with a higher risk of aspiration pneumonia [2,3] and the development of aspiration pneumonia is associated with longer hospital stays and higher mortality [4,5]
A total of 207 acute stroke patients with subarachnoid hemorrhage, cerebral infarction, or cerebral hemorrhage not caused by trauma, who were referred to the Outpatient Department of Dysphagia Rehabilitation, Dental Hospital, Tokyo Medical and Dental University from 1 April 2016, to 31 March 2019, and whose attending physicians requested dental intervention, were included in the study
The items that correlated with tongue coating index (TCI) were oral moistness (r = −0.269, p = 0.021) and tongue pressure (r = −0.247, p = 0.036)
Summary
Patients with acute stroke have a high incidence of dysphagia. Swallowing function is controlled by both brain hemispheres. The dominant hemisphere for controlling swallowing function is not known. If the right hemisphere is affected, it may cause aspiration and pharyngeal phase dysfunction, and if the left hemisphere is affected, oral phase dysphagia may result [1]. Dysphagia is associated with a higher risk of aspiration pneumonia [2,3] and the development of aspiration pneumonia is associated with longer hospital stays and higher mortality [4,5]. Marik et al [6] listed “risk factors for aspiration” as “neurogenic dysphagia,” “disorders of the esophagogastric junction,” and “anatomical abnormalities of the upper airway or upper gastrointestinal
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