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The occurrence of a cerebrovascular accident (CVA), commonly known as stroke, has a significant impact on a patient’s oral health. Dental hygienists can provide valuable support in the maintenance of oral hygiene as survivors recover and adjust to life after a stroke.

This article provides an overview of the role of hygienists in assisting stroke patients with oral hygiene care.

Stroke and Oral Hygiene

Cerebrovascular accident (CVA), commonly known as stroke, affects millions of people each year. It is the fifth leading cause of death for Americans and the third for Canadians. In some cases (particularly in elderly patients) stroke causes severe and lasting disability.

Patients typically undergo extensive rehabilitation, including occupational therapy. Traditionally, it was physical therapists that helped patients regain oral hygiene skills following the incidence of a stroke.

However, cuts to healthcare benefits have resulted in many patients receiving less rehabilitation and little to no assistance in overcoming the challenges stroke can present in brushing, flossing and general oral self-care:

• Loss of coordination (apraxia) can make brushing and flossing difficult or impossible;
• Difficulty swallowing (dysphagia) can increase the time food spends in contact with the teeth;
• Facial paralysis (hemiplegia) can cause food debris to accumulate in the affected cheek without the patient’s knowledge;
• Difficulty articulating (dysarthria) hinders communication between the patient and dental professionals.

Additionally, many of the medications used to treat stroke survivors present side effects that further complicate their dental care:

• Anticonvulsants can cause gingival enlargement or hyperplasia, which can interfere with eating and speech, impede effective brushing, and force teeth out of alignment;
• Anticoagulants can cause excessive bleeding from the gums, which often discourages patients from dental self-care or seeking professional dental care;
• Blood pressure medications can cause dry mouth or xerostomia, with consequences ranging from mild oral discomfort to significant oral disease.

Each cerebrovascular accident case is unique; not all patients who are recovering from stroke present the same conditions or follow the same path in recovery. However, dental hygienists who wish to support these patients must be knowledgeable of the many ways stroke can impact the state of a person’s dental health and the ongoing care they require.

Assisting Stroke Patients with Oral Hygiene Care

Oral hygiene is an important part of a stroke survivor’s care and recovery. Regaining the ability to care for one’s teeth and gums gives patients a sense independence and control over their health.

For patients with lasting disabilities, dental hygienists can help empower the patient’s caregivers to provide quality dental care.

In most cases, patients are advised to wait at least six months after a stroke to receive non-urgent dental care, and to receive a post-CVA consultation with the patient’s physician. These are some of ways that dental hygienists can assist stroke patients with oral hygiene care:

1. If the patient uses oral hygiene aids at home, have the patient bring the products to the appointment and demonstrate their use. Hygienists can advise on the usage of these products to achieve the best possible results.
2. Hygienists can suggest products and methods that can help patients compensate for the loss of dexterity or cognitive impairment, such as floss holders, floss piks, electric toothbrushes, and brushes with a two-minute timer.
3. Patients who suffer from xerostomia as a side effect of medications can be given products and tips to help relieve dry mouth
4. For patients with cognitive impairment or memory loss, hygienists can assist by providing all oral hygiene instruction in both oral and written form and including the patient’s caregiver in all appropriate discussions.

Celebrating Dental Hygienists

October is National Dental Hygiene Month: an initiative to celebrate the hardworking, compassionate dental hygienists who contribute to the cause of improving oral health care. Sable Industries is proud to support your work.

We look forward to assisting you.