On World Oral Health Day this year, we consider the neglected and under-researched area of oral healthcare (OHC) in people suffering a stroke. Stroke survivors have a higher prevalence of poor oral health, including gingivitis, periodontal disease, dental plaque, xerostomia, tooth loss and use of dentures than people without a stroke. Poor oral health is linked to developing pneumonia due to aspiration of oral biofilm. Post-stroke pneumonia (PSP) is the most common complication of stroke, affecting 1 in 12 people hospitalised with a stroke. Swallowing impairment (dysphagia) is an important risk factor for PSP and occurs in around 45% of acute strokes. In those developing PSP, clinical outcomes are poor and there are very limited preventive strategies.

OHC is recognised by nurses as a fundamental aspect of nursing care. However, nursing staff report limited access to equipment and training, and it is consistently neglected. Nurses worry about causing harm (e.g. risk of aspiration) and additional training of nursing staff may improve OHC confidence and delivery.

Targeting poor oral health in acute dysphagic stroke patients could prevent PSP and improve clinical outcomes for patients. However, there is currently a lack of good quality research evidence to inform OHC in dysphagic stroke patients.

We have undertaken early phase trials of OHC interventions in acute stroke patients and developed an OHC education and training resource. Development and feasibility testing of an oral hygiene intervention for stroke unit care – PubMed

In our recent CHOSEN (CHlorhexidine Or toothpaSte, manual or powered brushing to prevent pNeumonia complicating stroke) trial, we evaluated the feasibility of a nurse-led complex OHC intervention in acute dysphagic stroke patients. The OHC treatments included an online and paper-based training resource for nurses and healthcare assistants. Chlorhexidine and powered brushing were well-tolerated and those allocated chlorhexidine gel preferred it to toothpaste.

Definitive phase 3 randomised trial evidence to inform OHC in stroke unit practice is urgently needed. We have therefore planned a phase 3 follow-on trial (CHOSEN-2) to investigate whether our chlorhexidine-based complex OHC intervention can reduce PSP and improve clinical and health economic outcomes in UK stroke unit care. We hope to launch CHOSEN-2 in 2027 so look out for updates on World Oral Health Day next year!

For further information please contact:

Professor Craig J Smith: craig.smith-2@manchester.ac.uk

Professor Liz Lightbody celightbody@uclan.ac.uk

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