The Effectiveness of Oral Health Promotion on Pneumonia Complicating Stroke

The Effectiveness of Oral Health Promotion on Pneumonia Complicating Stroke

To investigate the evidence for the integration of oral health promotion as part of interdisciplinary stroke rehabilitation.

Pneumonia complicating stroke is very difficult to manage and has a very poor prognosis, leading to a significantly higher risk of death. Oral opportunistic pathogens have been reported to be associated with the incidence of pneumonia among non-stroke immunocompromised subjects. Preliminary studies found that patients with stroke had higher carriage rates of oral opportunistic pathogens than healthy subjects. Therefore, investigators hypothesize that pneumonia complicating stroke is associated with oral opportunistic pathogens, and oral health promotion interventions may reduce the incidence of pneumonia complicating stroke via its effects on the species and relative abundance of oral opportunistic pathogens. In order to prove this, investigators need to (1) firstly conduct a randomized controlled trial to confirm whether oral health promotion is able to reduce the levels of plaque, and the incidence of pneumonia complicating stroke at clinical level; (2) secondly employ metagenomics analysis to compare oral rinse samples and respiratory samples, and to identify pneumonia-associated "oral opportunistic pathogens group"; (3) finally elucidate how oral health promotion influences the species and relative abundance of oral opportunistic pathogens. This proposed study will provide evidence for the integration of oral health promotion as part of interdisciplinary stroke rehabilitation.

Inclusion Criteria:

• having onset of stroke within 3 days and free of any post-stroke complication
• having moderate to severe functional disability- Barthel Index (BI) scores of <70
• being conscious and respiring voluntarily without ventilator
• not having any lung disease and lower respiratory infection
• not have an indwelling naso-gastric feeding tubes
• having dysphagia as showed by GUSS test (The Gugging Swallowing Screen, GUSS)
• having normal cognitive ability or mild impairment- Mini Mental State Examination (MMSE) >18
• having ability to follow instruction (as an assessment of compliance of oral health intervention)
• not having systemic administration of antibiotics
• not being edentulous

Exclusion Criteria:

• mild disability (Barthel Index > 70)
• having normal swallowing function
• edentulous
• having an indwelling naso-gastric feeding tubes
• having communication disorders, unable to cooperate with family caregivers for oral health promotion