Oral Care in Stroke Patients: An Observational Study of a Tertiary Care Center

For a variety of related reasons, stroke can adversely affect oral care. Physical impairment, coordination, sensory or cognitive deficits may accompany a stroke and can impact on independent oral care. Post-stroke alterations in facial muscle mass or movement and sensory problems may result in poorly controlled dentures.

Dysphagia can contribute to oral care concerns in a number of ways. Oral intake of fluids may be restricted to reduce the risk of aspiration pneumonia, which in turn can contribute to xerostomia. Nutritional supplements, often prescribed, are high in sugar and may predispose to caries. Furthermore, because of swallowing impairment, pharmacological interventions are often administered in syrup consistency, which is sugar-based, and may also predispose to caries. Reduced swallowing ability causes ineffective clearance of bacteria and debris from the mouth leading to caries and infection.

Some pharmacological interventions in stroke care are known to have oral side effects. Oxygen therapy frequently administered in acute stroke management is known to cause mucosal drying and blistering. The absence of normal chewing patterns as a result of pain, physical or sensory impairment can also reduce salivary function. Xerostomia also causes pain, taste disturbance, chewing, and swallowing difficulties.

Speech and denture retention is also affected by inadequate saliva. This, in turn, increases plaque formation, predisposes to opportunistic oral infections, periodontal disease, and caries, conditions which place the individual at greater risk of pain, tooth loss and tooth substance loss. Chronic periodontal infection is currently being tentatively linked with the incidence of the stroke itself, while others have demonstrated a relationship with other systemic diseases including pneumonia and cardiovascular disease.

Healthcare-led oral care is a complex intervention and comprises a number of elements. These include assessment, accessing further assistance as required, and the use of appropriate equipment and cleaning methods. Knowledge is also required to assess and apply oral care at an individual level.