Effect of oral hygiene interventions on oral opportunistic pathogens among patients undergoing outpatient rehabilitation following stroke

Abstract

OBJECTIVES: To evaluate the effectiveness of oral hygiene interventions on oral opportunistic pathogens among patients undergoing stroke rehabilitation. METHODS: The patients were randomized to one of two intervention groups for 3 months: (1) brush with a powered toothbrush, mouth rinsing with 0.2% chlorhexidine and oral hygiene instruction (OHI); and (2) brush with a manual toothbrush and OHI. Oral rinse samples were obtained at baseline, 3 months, and 6 months for detection of aerobic and facultatively anaerobic Gram-negative bacilli (AGNB) and yeasts. The samples were inoculated onto CHROMagar and MacConkey’s agar. After incubation, isolates were enumerated and identified by colony morphology, Gram stain, and commercial identification systems (API 20E/NE for AGNB, and ID32C for yeasts). RESULTS: This study included 94 patients, and the 3-month and 6-month follow-up rates were 78% and 62%, respectively. Within group 1, both the viable counts and detection rates of AGNB and yeasts remained stable over the course of the study. Within group 2, both the viable counts (p=0.016) and detection rate of AGNB (p=0.023) showed a significant increase after 6 months while no significant differences in the viable counts or the detection rates of yeasts were found. Compared to group 2, patients in group 1 harbored significantly lower viable counts of yeasts after 3 months (p=0.048) and of AGNB after 6 months (p=0.025). They also demonstrated a significantly lower detection rate of yeasts (p=0.027) as well as AGNB (p=0.041) after 6 months. CONCLUSIONS: The study package of mechanical and chemotherapeutic oral hygiene care lacked effectiveness in eliminating two major opportunistic pathogens; however, it may prevent their proliferation during the active intervention and post intervention periods, compared to standard oral hygiene care.