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Dziewulska A, Pawlukowska W, Zawiślak A, Masztalewicz M, Grocholewicz K. Oral Health in Patients Hospitalized Because of Ischemic Stroke. J Clin Med 2024; 13:4556. [PMID: 39124822 PMCID: PMC11312497 DOI: 10.3390/jcm13154556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 08/01/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Maintenance of good oral health is relevant to overall health and quality of life. Results of many analyses showed that stroke patients had worse oral health than the control population. The aim of this study was a clinical assessment of oral condition in post-stroke patients and a healthy population. Methods: Oral health was assessed in stroke patients on the first day of ischemic stroke, and in a control group of healthy subjects. The number of teeth, the presence of active carious foci, fillings, and prosthetic restorations were evaluated. To assess oral hygiene, the Approximal Plaque Index (API) was used. In periodontal examinations, the presence of dental deposits, the depth of the existing periodontal pockets, tooth mobility, and the Sulcus Bleeding Index (SBI) during probing were assessed. Results: Significantly higher mean values of Decayed Teeth (DT), Missing Teeth (MT), and Decayed, Missing, and Filled Teeth (DMFT) indices were recorded in the study group. The incidence of dental caries, API, and SBI was also significantly higher in the study group. The study and control groups did not differ significantly in the average number of pockets 3 mm deep and deeper and in the frequency of having prosthetic restorations. Conclusions: Oral health and the level of oral hygiene in patients hospitalized because of ischemic stroke, in comparison with that in a healthy population, is not satisfactory. Active interdisciplinary collaboration between various medical specialists in the therapy of patients with general illnesses, including stroke, is strongly recommended.
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Affiliation(s)
- Anna Dziewulska
- Department of Interdisciplinary Dentistry, Pomeranian Medical University, 70-111 Szczecin, Poland
| | | | - Alicja Zawiślak
- Department of Interdisciplinary Dentistry, Pomeranian Medical University, 70-111 Szczecin, Poland
- Department of Maxillofacial Orthopedics and Orthodontics, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Marta Masztalewicz
- Department of Neurology, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Katarzyna Grocholewicz
- Department of Interdisciplinary Dentistry, Pomeranian Medical University, 70-111 Szczecin, Poland
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Bagdesar M, Samuel R, Brown TDG, Shetty S, Kaur J, Kong AC, George A, Ajwani S. Integrated oral care for patients with spinal cord injuries: perceptions of non-dental professionals. Disabil Rehabil 2024:1-10. [PMID: 38910433 DOI: 10.1080/09638288.2024.2367599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE To understand the oral health attitudes, knowledge, and practices among non-dental professionals caring for patients with spinal cord injuries, as well as the barriers and facilitators to oral care across acute and rehabilitation hospital settings. MATERIALS AND METHODS This study was a descriptive qualitative study. Nine focus groups with spinal cord injury clinicians from two Sydney hospitals were conducted (n = 35). A thematic analysis was undertaken. RESULTS Four themes were constructed: understanding the impact of spinal cord injuries on oral health and wellbeing; limited support in the spinal cord injury unit to promote oral care; strategies that enable oral care promotion; and recommendations to expand scope in oral care and education. Although most clinicians considered oral health to be important there was a lack of guidelines to support standardised oral care practices. Barriers included lack of time, limited oral care resources, low priority and difficulty in accessing treatment. Staff were receptive to an integrated, multidisciplinary approach to oral care. CONCLUSION This Australian first study provides insight into spinal cord injury clinicians' knowledge and practices of oral care. The findings will help guide future research in developing appropriate models of care to promote oral health among patients with spinal cord injuries.
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Affiliation(s)
- Mary Bagdesar
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, Sydney, NSW, Australia
| | - Rebecca Samuel
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, Sydney, NSW, Australia
| | - Travis D G Brown
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, Sydney, NSW, Australia
- Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Sachin Shetty
- Spinal Injuries Unit, Prince of Wales Hospital, Sydney, NSW, Australia
- Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
| | - Jasbeer Kaur
- Spinal Cord Injury Unit, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ariana C Kong
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW, Australia
- ACIOH, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Ajesh George
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, Sydney, NSW, Australia
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW, Australia
- ACIOH, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Shilpi Ajwani
- Sydney Dental School, Faculty of Medicine and Health, University of Sydney, Surry Hills, Sydney, NSW, Australia
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW, Australia
- Oral Health Services, Sydney Dental Hospital, Surry Hills, NSW, Australia
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Konadu AB, Iwuozo EU, Sunkwa-Mills G, Ayoola YA, Manu EA, Hewlett SA, Dedey F, Abdulkadir MB, Ogedegbe O. Healthcare professionals' perspectives on oral health care in acute stroke patients: a qualitative study. BDJ Open 2024; 10:52. [PMID: 38898008 PMCID: PMC11187067 DOI: 10.1038/s41405-024-00238-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Stroke is a major public health problem, with the disabilities of the patients increasing their risk of poor oral health. Currently, in Ghana and Nigeria, no guideline exists for oral health care in stroke patients, while most of our acute stroke care settings have no documented protocol. AIM This study sought to understand the perspectives of healthcare professionals in Ghana and Nigeria about oral healthcare in acute stroke patients. METHODS A qualitative inductive approach was employed to explore healthcare professionals' perspectives. After obtaining informed consent, in-depth interviews were conducted among doctors, nurses, and physiotherapists using semi-structured question guides. Participants' responses were audiotaped for transcription and analysis. Interviews were conducted until data saturation was reached. Data were analyzed thematically to generate themes and sub-themes using an inductive approach. THE RESULTS Twenty-five (25) health care professionals (HCP) aged 25-60 years with a mean age of 36.2 ± 4.2 years were interviewed. There were 15 (60.0%) males and 10 (40.0%) females. HCP included nurse practitioners 14 (56.0%), medical doctors 7 (28.0%), and physiotherapists 4 (16.0%). The HCP demonstrated adequate knowledge of stroke and considered oral health important for esthetic and clinical reasons. They, however, reported being unable to give it the required attention due to inadequate collaboration between the various professional cadres, insufficient equipment, and a skewed focus on other clinical needs of the acute stroke patients. CONCLUSIONS The findings indicate that HCPs perceived oral health care as very important among patients with acute stroke. However, they reported a lack of collaboration and integration of oral health care in routine stroke care as a major impediment.
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Affiliation(s)
- Akua Boakyewaa Konadu
- Department of Restorative Dentistry, University of Ghana Dental School, Accra, Ghana.
| | - Emmanuel U Iwuozo
- Neurology Unit, Internal Medicine Department, Benue State University Teaching Hospital Makurdi, Makurdi, Benue State, Nigeria
| | - Gifty Sunkwa-Mills
- Municipal Health Directorate, Awutu Senya East Municipal GHS, Awutu Senya East, Ghana
| | - Yekeen A Ayoola
- Department of Medicine, Gombe State University, Gombe, Nigeria
| | - Ewura A Manu
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
| | - Sandra A Hewlett
- Department of Restorative Dentistry, University of Ghana Dental School, Accra, Ghana
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | | | - Olugbenga Ogedegbe
- Institute of Excellence in Health Equity, NYU Langone, New York, NY, USA
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An R, Jiang G, Wu Z, Liu M, Sohaib M, Chen W. Perceptions and experience of rural older people in oral health management in China: a qualitative study. BMC Oral Health 2024; 24:644. [PMID: 38822319 PMCID: PMC11143558 DOI: 10.1186/s12903-024-04401-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/23/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND To explore the perceptions and experience of oral health management among rural older people in China. METHODS Qualitative methodologies were used in this study. Face-to-face semi-structured interviews were conducted. Thirteen older adults in rural areas were purposively sampled at two metropolitan hospitals in Hunan, China. The data were transcribed and thematically analyzed, and MAXQDA software was used to assist with coding. RESULTS Three overarching major themes and ten sub‑themes capturing the perceptions and experience of oral health management among rural older people were identified. Three themes emerged from the thematic analysis: oral health cognitive bias, poor management behaviors, and limited oral health services. Oral health management as a whole is negative, oral health behaviors are poor, oral health service utilization is limited. CONCLUSIONS Based on these findings, there is great scope here for improving the current status of oral health for rural older people around awareness, behavior, and access. Oral health education, improved oral health services and primary oral health promotion are warranted.
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Affiliation(s)
- Ran An
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, Hunan Province, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Guanghua Jiang
- College of Nursing, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Zitong Wu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Meizi Liu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Muhammad Sohaib
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, Hunan Province, China
| | - Wenfeng Chen
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, Hunan Province, China.
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Davies R, Doshi M. Prevention of oral diseases for the older person (Part 1). Br Dent J 2024; 236:35-41. [PMID: 38225311 DOI: 10.1038/s41415-023-6610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Older adults often experience poorer levels of oral health than younger adults, especially if they have become dependent on a third party to support their daily oral care routine. However, the deterioration of oral health does not need to be a part of the ageing process. Most oral diseases are largely preventable with the daily removal of dental plaque that forms on teeth and dentures, using a fluoride toothpaste, eating a healthy diet and reducing any tobacco consumption. The dental team have a duty of care to ensure that older people receive evidence-based oral health preventative advice tailored to the individual, taking into account individual risk factors that can increase with age. This can include the clinical application of topical fluoride and minimally invasive dentistry. Older people at an increased risk of poor oral health include those with cognitive conditions, physical impairments and certain medical conditions. Care home residents face particular barriers to attaining a satisfactory standard of oral care which are discussed herein. Good oral health preventative routines must be established early after the diagnosis of progressive chronic conditions and will help to prevent the need for dental intervention later in life when treatment can be more difficult to tolerate. Inclusion of oral health prevention within health policy and legislation is necessary to improve the oral health for older people living in all health and care settings.
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Affiliation(s)
| | - Mili Doshi
- Dental and Maxillofacial, Surrey and Sussex Healthcare NHS Trust, Surrey, United Kingdom.
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Cardoso AF, Ribeiro LE, Santos T, Pinto M, Rocha C, Magalhães J, Augusto B, Santos D, Duque FM, Fernandes BL, Sousa RC, Silva R, Ventura F, Fernandes AM, Cardoso D, Rodrigues R. Oral Hygiene in Patients with Stroke: A Best Practice Implementation Project Protocol. NURSING REPORTS 2023; 13:148-156. [PMID: 36810267 PMCID: PMC9944467 DOI: 10.3390/nursrep13010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Oral hygiene has been shown to reduce adverse events and promote the quality of life of patients with stroke. However, a stroke can result in the impairment of physical, sensory, and cognitive abilities, and comprise self-care. Although nurses recognize its benefits, there are areas for improvement in the implementation of the best evidence-based recommendations. The aim is to promote compliance with the best evidence-based recommendations on oral hygiene in patients with stroke. This project will follow the JBI Evidence Implementation approach. The JBI Practical Application of Clinical Evidence System (JBI PACES) and the Getting Research into Practice (GRiP) audit and feedback tool will be used. The implementation process will be divided into three phases: (i) establishing a project team and undertaking the baseline audit; (ii) providing feedback to the healthcare team, identifying barriers to the implementation of best practices, and co-designing and implementing strategies using GRIP, and (iii) undertaking a follow-up audit to assess the outcomes and plan for sustainability. So, the successful adoption of the best evidence-based recommendations on oral hygiene in patients with stroke will reduce the adverse events related to poor oral care and may improve patients' quality of care. This implementation project has great transferability potential to other contexts.
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Affiliation(s)
- Ana Filipa Cardoso
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- Correspondence:
| | - Liliana Escada Ribeiro
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Teresa Santos
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Maribel Pinto
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Cláudia Rocha
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Joana Magalhães
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Berta Augusto
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Diana Santos
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Filipa Margarida Duque
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | - Beatriz Lavos Fernandes
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- Hospital de Cascais Dr. José de Almeida, Av. Brigadeiro Victor Novais Gonçalves, 2755-009 Alcabideche, Portugal
| | - Rosário Caixeiro Sousa
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- Hospital da Luz, Praceta Robalo Cordeiro, 1, 3020-479 Coimbra, Portugal
| | - Rosa Silva
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal
| | - Filipa Ventura
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | - António Manuel Fernandes
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal
| | - Daniela Cardoso
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal
| | - Rogério Rodrigues
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal
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Ghaddar Z, Matar N, Noujaim J, Diep AN, Tohmé A, Pétré B. Consensus on the Objectives of an Educational Intervention for Patients with Oropharyngeal Dysphagia and Their Informal Caregivers: A Delphi Study. Patient Prefer Adherence 2022; 16:1511-1524. [PMID: 35769338 PMCID: PMC9236548 DOI: 10.2147/ppa.s364520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In the absence of literature allowing for an evidence-based approach to therapeutic patient education (TPE) in Oropharyngeal Dysphagia (OD), this study aims to reach a consensus of experts on the content of a competency framework of an educational program for OD patients and their informal caregivers (ICGs). METHODS We used the Delphi consensus-building method. Four categories of experts were recruited: 12 patients, 17 ICGs, 46 healthcare professionals (HCP) (experienced in OD, not necessarily certified in TPE), and 19 experts in TPE (trained individuals to set up and run TPE programs not necessarily HCPs). The content of the questionnaire of the first round (R) was established according to the result of a scoping review and the opinion of an expert committee. We carried out three rounds. In R1 and R2, we collected the opinions on the relevance (7-point Likert-type scale) and on comprehensiveness (YES/No question and asking participants to propose additional content). Participants were also invited to leave comments on each objective. In R3, we asked the participants to give their opinion about the relevance of the objectives again and asked them to rank the themes from highest to lowest priority. RESULTS Objectives were considered relevant for all participants if they reached consensus when the interquartile (IQR) ≤ 1, and if the median indicated agreement (Mdn ≥ 6) (6= appropriate, 7 = totally appropriate). Following three rounds, the final content of the educational program is composed of 23 educational objectives organized in 13 themes with an agreement about relevance amongst all participants (Mdn ≥ 6; IQR ≤ 1). The comprehensiveness criterion received also a consensus (IQR ≤ 1). The participants ranked the theme "normal swallowing vs difficulty swallowing" as the highest priority. CONCLUSION This Delphi study resulted in a consensus, on the content of a competency framework of an educational program for OD patients and their ICGs. Further steps are needed to construct learning activities based on these objectives before testing their feasibility and efficacy.
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Affiliation(s)
- Zahya Ghaddar
- Department of Public Health, University of Liège, Liege, Belgium
- Doctoral School of Sciences and Health, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
- Department of Higher Institute of Speech and Language Therapy, Saint Joseph University of Beirut, Beirut, Lebanon
- Correspondence: Zahya Ghaddar, Department of Public Health, University of Liège, Place du XX août 7, Liege, 4000, Belgium, Tel +961 3554813, Email ;
| | - Nayla Matar
- Department of Higher Institute of Speech and Language Therapy, Saint Joseph University of Beirut, Beirut, Lebanon
- Department of Otolaryngology-Head and Neck Surgery, University Hospital Center Hotel-Dieu de France, Affiliated to Saint-Joseph University, Beirut, Lebanon
| | - Joyce Noujaim
- Department of Higher Institute of Speech and Language Therapy, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Anh Nguyet Diep
- Department of Public Health, University of Liège, Liege, Belgium
| | - Aline Tohmé
- Department of Internal Medicine and Clinical Immunology, University Hospital Center Hotel-Dieu de France, Affiliated to Saint-Joseph University, Beirut, Lebanon
| | - Benoit Pétré
- Department of Public Health, University of Liège, Liege, Belgium
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