Patients with stroke have poorer oral health

In many Western nations stroke is a leading cause of death and disability. With an ageing population the number of patients suffering with stroke is likely to increase.

The aim of this study was to review clinical oral health status and oral self-care behaviours of patients with stroke.

Methods

Searches were conducted in Medline, Embase and the Web of Science for observational studies relating to oral health outcomes (clinical, microbiological and immunological attributes) and oral health-related behaviours of patients with a previous diagnosis of stroke.

Studies were independently screened by two reviewers with quality being assessed using the Methodological Evaluation of Observational Research (MORE) criteria. Outcomes regarding tooth condition, periodontal condition, oral hygiene status, and dental attendance were pooled for seven meta-analyses. Narrative summaries were provided for those outcomes which could not be pooled for meta-analysis.

Results

23 papers reporting 20 studies were included.
Meta-analysis (5 studies) found that the control group had a significantly greater number of teeth compared to the stroke group
Meta-analysis (2 studies) found
- A significantly higher mean DMFT in stroke patients [standardized difference in means: 0.246, 95% CI (0.096–0.396) , p=0.001.
- Plaque index (PI) and gingival index (GI) to be significantly higher in stroke patients [standardized difference in means of PI: 0.305, 95% CI (0.165, 0.444), p < 0.0001].
3 studies reporting clinical attachment loss could by included in a meta-analysis finding clinical attachment loss (CAL) and probing depth (PD) to be significantly higher in the stroke group.
Patients with stroke were significantly less likely to have an annual dental visit [odds ratio: 0.493, 95% CI (0.372, 0.652), p < 0.0001, fixed effect;
For those outcomes which could not be pooled for meta-analysis, it was not possible to draw any qualitative conclusion due to the equivocal results of these studies.

Conclusions

The authors concluded

There is an increasing interest in oral health of patients with stroke. Patients with stroke had a poorer clinical oral health status across a range of parameters (tooth loss, dental caries experience, and periodontal status). Coupled with this, their dental attendance was less frequent. Further studies employing standardized assessments of oral health/oral health behaviour can confirm these oral health disparities.

Commentary

With an increasing elderly population with more teeth due to improvements in oral health there will be greater demands or oral health services. An increasing elderly population will also lead to a great number of these patients suffering with stroke. Maintaining their oral health has a key contribution to quality of life and it may also impact on post-stroke infections such as aspiration pneumonia. This review, as the authors note is restricted to English language studies so some studies may have not been identified. Only a small number of studies could be included in the meta-analysis and although statistically significant the difference found may not be clinically significant.