A Dentist-Led Oral Care System Can Prevent Stroke-Associated Pneumonia: The Effects of Early Intervention by Dental Team

Kenichiro Ozaki,1,2 Haruka Tohara,2 Mikoto Baba,1 Satoshi Teranaka,1,3 Yosuke Kawai,1,3 Satoru Komatsumoto4,5 1Department of Physical Medicine and Rehabilitation, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; 2Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan; 3Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan; 4Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; 5Fujita Health University, Toyoake, Aichi, JapanCorrespondence: Kenichiro Ozaki, Department of Physical Medicine and Rehabilitation, Ashikaga Red Cross Hospital, 284-1, Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan, Tel +81-284-21-0121, Fax +81-284-21-6810, Email oza-gerd@tmd.ac.jpBackground: Our facility’s dental team consists of a full-time dentists and dental hygienists who work exclusively in the wards to implement best practices in oral healthcare. We executed the dental care system (DCS) that includes lectures and practical training for nurses conducted by dentists and dental hygienists, the introduction to oral assessment, standardization of oral care procedures, a process for nurses to request the dental team, and early bedside oral screening conducted by the dental team. This study investigated the DCS’s effects on the incidence of stroke-associated pneumonia (SAP).Methods: This single-center retrospective cohort study included 2,771 acute stroke patients who were newly hospitalized between April 1, 2012, and March 31, 2020. The 8-year period was divided into four phases at two-year intervals as follows: Pre (N=632), Post-1 (N=642), Post-2 (N=716), and Post-3 (N=781). Pre was prior to DCS practice. Post-1 was an early introduction to DCS. Post-2 simplified dental team requests from nurses, and Post-3 added bedside oral screening within 72 hours of admission by the dental team. Statistical analysis was performed using the Cochran-Armitage trend test, followed by multivariate logistic regression.Results: A decrease in SAP rates was observed across the four groups (P< 0.0001). Logistic regression analysis revealed a significant difference for respiratory disease (odds ratio 7.74, 95% confidence interval 5.49– 10.90), hypertension (2.28, 1.39– 3.73), cardiac failure (1.72, 1.04– 2.85), and diabetes (1.59, 1.11– 2.26), 3-digit code on the Japan coma scale (3.57, 2.53– 5.05 [reference ≤ 2-digit code]), age ≥ 90 years (2.34, 1.15– 4.77 [reference 18– 59 years]), male (1.86, 1.31– 2.67), and the Post-1 (0.49, 0.31– 0.76 [reference Pre]), Post-2 (0.38, 0.25– 0.61 [reference Pre]), and Post-3 (0.24, 0.15– 0.40 [reference Pre]) periods.Conclusion: The suppression of SAP is effectively achieved through early intervention and education of nurses by dental professionals.Plain Language Summary: Pneumonia is a dangerous disease that kills millions of individuals around the world every year. Stroke patients are susceptible to developing pneumonia because their swallowing reflex is sometimes impaired. This risk may be reduced by maintaining oral hygiene through advanced oral care involving dentists and dental hygienists. For this reason, our acute care hospital has a dental team consisting of a full-time dentists and dental hygienists dedicated to the ward. In 2014, the dental team launched a program for nurses on how to provide oral care to inpatients. Additionally, we have introduced a system that enables nurses to contact the dental team immediately if oral care becomes difficult for nurses due to problems in the patient’s mouth. Furthermore, the dental team began evaluating the oral health of all stroke patients within 72 hours after hospitalization. We studied the changes in the frequency of pneumonia in stroke patients at our hospital before the application of this approach and 6 years after its introduction. The rate of pneumonia decreased steadily during this period. Overall, the pneumonia rates in stroke patients at our hospital reduced by approximately 60%, suggesting that this system is an effective way to prevent pneumonia.Keywords: hospital dental services, hospital dentistry, special care dentistry, oral health management, oral care, acute stroke, stroke-associated pneumonia, team approach