A systematic review and meta-analysis of clinical, microbiological, and behavioural aspects of oral health among patients with stroke

• Published in: Journal of dentistry 2015-02, Vol.43 (2), p.171-180
• Main Authors: Dai, Ruoxi, Lam, Otto L.T, Lo, Edward C.M, Li, Leonard S.W, Wen, Yifeng, McGrath, Colman
• Format: Article
• Language: English
• Subjects: Behavior; Biomarkers - metabolism; Case-Control Studies; Dental Caries - complications; Dentistry; Gingiva - pathology; Health Behavior; Hospitals; Humans; Meta-analysis; Mortality; Observational studies; Odds Ratio; Oral Health; Oral Hygiene; Periodontium - pathology; Stroke; Stroke - complications; Stroke - immunology; Stroke - microbiology; Stroke - psychology; Studies; Systematic review; Teeth; Tooth Loss - complications; Validity
• ISSN: 0300-5712; 1879-176X
• DOI: 10.1016/j.jdent.2014.06.005

Abstract Objective The objective of this study was to review clinical, microbiological, and immunological aspects of oral health, as well as oral health related behaviours among patients following stroke. Data sources A structured search strategy was applied to three electronic databases to identify relevant papers. Study selection The initial search yielded 19,927 papers, 60 potentially relevant studies (Kappa: 0.974) and 23 relevant papers (Kappa: 0.965) in accordance with the inclusion criteria. Outcomes regarding tooth condition, periodontal condition, oral hygiene status, and dental attendance were pooled for seven meta-analyses. Narrative summaries were provided for those outcomes which could not be pooled for meta-analysis. Results The standardized differences in mean values of the parameters (fixed effect, random effect model) for patients with stroke compared to control groups were: number of teeth (−0.325, −0.271), DMFT (0.246, 0.246), oral hygiene status – plaque index (0.305, 0.356) and gingival index (0.716, 0.653), periodontal health status – clinical attachment loss (0.437, 0.490) and probing depth (0.470, 0.579). In addition, a lower chance of dental attendance was observed among patients with stroke (odds ratio: 0.493, 0.480). For those outcomes which could not be pooled for meta-analysis, it was not possible to draw any qualitative conclusion due to the equivocal results of these studies. Conclusions There is an increasing interest in oral health of patients with stroke. Patients with stroke had a poorer clinical oral health status across a range of parameters (tooth loss, dental caries experience, and periodontal status). Coupled with this, their dental attendance was less frequent. Further studies employing standardized assessments of oral health/oral health behaviour can confirm these oral health disparities. Clinical significance With comprehensive literature search, this systematic review and meta-analysis indicated a poorer oral health status and less frequent dental attendance behaviour among patients with stroke.