Oral Health Assessment in Patients with Post-stroke Dysphagia
1 Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
2 Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
3 Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
4 Department of Nursing, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
5 Department of Nutrition, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Post-stroke dysphagia (PSD) is a common complication after acute stroke, leading to increased mortality and morbidity due to aspiration, pneumonia, and malnutrition. PSD predicts the poor outcome and institutionalization. It was estimated 11%–50% occurrence of dysphagia at six months after stroke. Previous studies concluded oral health and stroke were related. Periodontitis and tooth loss were notable factors of stroke. However, there was limited discussion about oral health in PSD. Herein, we aimed to investigate the association between dysphagia and oral health in stroke patients.
MATERIAL and METHOD:
We enrolled subjects with ischemic stroke in the Neurological department of Kaohsiung Municipal Siaogang Hospital between Jan. 2020 and Nov. 2020. Dysphagia was evaluated based on the eating assessment tool (EAT-10), with EAT-10 total scores ≧3 indicating dysphagia. Oral health state was evaluated by using oral health assessment tool (OHAT). OHAT comprised eight sub-items, namely lips, tongue, gums and tissues, saliva, natural teeth, dentures, oral cleaniness, and dental pain, with rating of 0= health, 1=changes, 2=unhealthy. Total OHAT scores≧ 2 indicatied the unhealthy oral state. We demonstrated the oral health in PSD and compared the difference of unhealthy oral state in subjects with and without PSD.
In total, we enrolled 264 subjects with ischemic stroke in our study, with 159 subjects (60.2%) aged above 65 years old, and 89(33.7%) being female. Among them, there were 100 (37.9 %) with PSD and 119 (45.1 %) with unhealthy oral state. There was no difference of total OHAT scores and age between PSD and without PSD. (for OHAT scores, 1.7±1.6 vs 1.5± 1.7, p=0.399; for age, 69.2±12.6 vs 67.6±13.4, p=0.208). Among PSD, The most appeared unhealthy oral state in sub-items were natural teeth (26%), followed by dentures (12%) and oral cleaniness (7%).
We concluded near 40% of PSD and 45% unhealthy oral state in stroke patients. There was no association between oral health and PSD. Near 1/4 of PSD had problems of natural teeth (four or more decayed or broken teeth/roots, or very worn down teeth, or less than 4 teeth with no denture).