Oral health after stroke: A mixed-methods study involving healthcare professionals, stroke survivors and primary caregivers.

Abstract

Objectives: Maintaining good oral health after stroke is challenging due to physical and cognitive impairments and hospital-related factors. This study aimed to understand the oral and/or denture care (ODC) practices of healthcare professionals (HCPs) and explore the oral health and ODC experiences of stroke survivors (StS).

Methods: We used a mixed-methods approach. Quantitative data were derived from a survey of HCPs in acute stroke care and rehabilitation and from a retrospective chart review of admissions over one year. An embedded qualitative multiple case study with StS admitted to rehabilitation gathered information from care observations, oral examinations, semi-structured interviews, and charts.

Results: The survey involved 32 HCPs. All believed that ODC was part of self-care and over 90% believed that toothbrushing helps patients feel better and provides comfort while eating. However, 59% indicated insufficient training to perform oral health assessments and provide ODC. The chart review included 168 charts: 103 from acute care and 65 from rehabilitation. Notations about patient oral health status were written by nurses or speech-language pathologists in 46% and 65% of acute care and rehabilitation charts, respectively. ODC occurred less than once/day in acute care. In rehabilitation, occupational therapists assessed ODC functions in 55% of patients, but documentation of ODC provision was lacking. Qualitative themes from the case study included i) Valued oral health and ODC, ii) Independent ODC before stroke, iii) inconsistent support for ODC in acute care, iv) increased self-efficacy despite irregular ODC during rehabilitation, and v) ongoing reliance on caregivers or staff for ODC.

Conclusions: This study identified significant gaps in oral health and ODC practices during post-stroke hospitalization despite attention to oral health from HCPs. Both settings lacked evidence-based ODC approaches tailored to patient needs. We advocate for protocols that include oral screening tools, promote twice-daily toothbrushing, and incorporate ODC education for HCPs, StS, and caregivers.