Stroke and Oral Health

It's World Stroke Day! So let's learn about strokes and how this can affect oral health and the care we deliver for our patents...

Stroke is the third commonest cause of death and is the most common cause of severe disability in the UK, and this is likely to be on the rise since the pandemic, where COVID-19 has been implicated in an increased risk of having a stroke. Most people affected are over 65 years old, but 1,000 people under 30 also have a stroke every year. 

What is a Stroke?

Stroke, or a cerebrovascular accident (CVA) is due to partial or total obstruction of blood flow to the brain. This obstruction is either from a bleed (haemorrhagic), or a clot (ischaemic). 

People can also have a mini-stroke, a transient ischaemic attack (TIA), when the blood supply is briefly interrupted. The symptoms are similar to a stroke but are temporary and disappear within 24 hours. 

Signs of a stroke:

  • Numbness, weakness or paralysis on one side of the body e.g. drooping arm, dribbling mouth
  • Slurred speech or difficulty finding words or understanding speech
  • Sudden blurred vision or loss of sight 
  • Problems in thinking, memory, concentration (sudden onset) 

How does this affect Oral Health?

People who survive a stroke go through rehabilitation to help them regain their independence. This can involve the following:
  • Physiotherapy
  • Speech and Language Therapy
  • Occupational Therapy 
Oral health fits into all of the rehabilitation journey too and can be overlooked. Self-care can be a challenge if they have limited mobility or dexterity. Cognitive issues such as memory loss or confusion can result in a lack of oral care or relying on others to provide this care for them. 

Physical impairments may increase barriers to accessing dental care, for example if they are using a wheelchair or find it difficult to get out of their house. 

Their oral health risk can increase also. Poor oral hygiene or relying on someone else to brush their teeth can increase caries or periodontal risk. Nutritional supplements prescribed during rehabilitation can also be cariogenic and other medications prescribed can cause xerostomia. 

Poor muscular control can lead to difficulty in tolerating removable prostheses and if they also have a poor swallow, they will be an an increased aspiration risk too. 

Top Tips in Oral Care for Stroke Survivors

  • Communication might be impaired so liaise with Speech and Language therapists to get to know the best way to communicate with the patient - this can be written cards, charts, or even computer systems 
  • Consider domiciliary care if there are mobility issues, or refer to services which have specialist equipment such as WC recliners or hoists
  • Adapt oral health aids for those with dexterity issues e.g. adapt toothbrush handles with putty or a tennis ball, or use of an electric toothbrush
  • Create oral health plans for patients who need support with their oral health care
  • Focus on prevention! Prescribing high fluoride toothpaste or varnish for example for root caries
  • Shorter appointment times might be more appropriate as patients might become tired
  • Be mindful of their aspiration risk - treat sitting up and with really good suction if using water
  • Be wary of medications, for example, many patients will be prescribed anticoagulant medications such as warfarin. Refer to SDCEP guidance for planning their care

For more information about oral care and stroke, please see these British Society of Gerodontology Guidelines

Any questions about care for people who survive strokes? Please leave them in the comments below.

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