Improving stroke recovery through better mouth care

The problem

After a stroke, many patients develop swallowing difficulties (dysphagia). This can allow bacteria from the mouth to enter the lungs, increasing the risk of pneumonia, one of the most common and serious complications during stroke recovery.

What the researchers did

Researchers wanted to find out whether improving oral health care for patients in hospital after a stroke could help reduce the risk of pneumonia.

The CHOSEN feasibility trial (Chlorhexidine or Toothpaste, Manual or Powered Brushing to Prevent Pneumonia Complicating Stroke) tested whether an enhanced oral care programme could be delivered on hospital stroke wards. The study aimed to recruit 120 patients with acute stroke and swallowing difficulties from four stroke units in north-west England. Participants were randomly assigned to one of four oral care approaches using a manual toothbrush or powered toothbrush with either non-foaming toothpaste or chlorhexidine 1% gel. Stroke unit nursing staff received standardised education and training to support consistent delivery of mouth care.

What they found

The study showed that the enhanced oral care programme could be successfully introduced in stroke units and was acceptable to both patients and healthcare staff. The findings demonstrated that it was feasible to deliver and evaluate these different oral care approaches in routine stroke care.

Why this research matters

Improving everyday mouth care after stroke has the potential to reduce serious complications such as pneumonia and support recovery. The findings from CHOSEN have informed plans for a larger follow-on study to test cost-effectiveness of the oral healthcare treatments, which would change clinical practice.