03-09-2015
Aarhus University
Department of Clinical Medicine
HEALTH
Aarhus University
 Talk of the Day!!
Oral health- something to worry about in Neuro
rehabilitation settings ?
• Do we really have a problem?
• How to identify? – Screening/ Indexing
• How big/ severe is the problem? - Screening
• How to solve the problem? - Treatment plan
• Are there any firm treatment plans? - Mixed
Mohit Kothari BDS, PhD
Hammel Neurocenter
• Can acute care setting be translated into rehabilitation arena
or it requires some modification?
Aarhus University
 Key components of oral health
Aarhus University
 Left unnoticed in the oral cavity
• Teeth
• Tongue
• Gingiva (bleeding and redness)
• Mucosal lining
• The dorsal posterior aspect of the tongue
is major source of microorganisms as
cleaning is not undertaken as a routine
• Interproximal area of teeth
• Lips (dry/cracked)
• Saliva- consistency, production (hyper/hypo)
• Swallowing habits
Aarhus University
 Standard oral care protocol
Aarhus University
 Recommended in our set-up
• Standard foam tooth paste
• Tooth brush
 Pediatric (soft-bristled baby tooth brush)
 Electric tooth brush (Research shows the best
outcome)
• Foam sticks
•
• Adult/ and seldom pediatric manual tooth brush
• Saline as a rinse
• Lubricant
Toothpaste
 Fluoridated non-foaming tooth paste (readily
rinsed)
• Dental Floss
• Oral moisturizers
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03-09-2015
Aarhus University
 Recommended in our set-up
•
Suction devices (tip)
•
Bite Blocks
•
Tongue Scrapers (backward to forward)
Aarhus University
 Introduction (What has been proven so far?)
• Incidence of neurological patients- ageing
population
• Combination of motor, sensory, perceptual and
cognitive deficit- Impacts ADL
• Three dimensions of oral self care: Function,
education and training, and compliance
Aarhus University
Aarhus University
 Introduction (What has been known so far?)
 But on the other end…
• Dental plaque and oral pathogen loads: possible
starter/ worsens systemic health problems or viceversa
• Various clinical guidelines and assessments
Each country has oral health guidelines
Oral Assessment Guide (OAG)
Bed side Oral Examination (BOE)
• Commonest condition associated with systemic
disease: Periodontitis
Aarhus University
 Why Oral Health care not a priority ?
• Common barrier to effective oral care
Perception oral care doesn’t provide
significant benefits
Inadequate nursing staff
Few trainings and unfocused care policies
Even expressed strong dislike for oral care
At least 15 articles in Critical Nursing Care, Gerodontology etc.
• Research protocols
Clinical measurements (1-12)
Microbiological examination
Immunological aspect
Socio-behavioral aspect
Aarhus University
Need for a planned, easy to follow, tailor-made protocol
for the staff in rehabilitation settings
• Protocol should be:




Easy to follow
Cost effective
Simple bedside oral examination protocol
Without an extra burden to present clinical staff
• Aim: Comprehensive oral health assessment
in neuro rehabilitation setting
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03-09-2015
Aarhus University
Aarhus University
 Materials and Methods
 Possible assessment tool (Measurements)
• 12 ABI patients from semi-intensive care unit (one
ward)
• Social History
• Self administered structured questionnaire
• Full mouth clinical examination protocol
• Entire examination took: 60 minutes
 Gender/ Age/Marital
Status/Education/Alcohol/Smoke/ Medical History
• Behavioral aspects
 Dental visit/ Only when had some trouble
 Tooth brushing frequency
• EFA and its oral health sub score
• Onset of Disease (Time since injury)
Aarhus University
 Dental Armamentarium
• Mouth Mirror
• Arch Explorer
• UNC-15 probe
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 Clinical measurements
• Plaque and calculus indexing
• Pocket depth indexing
• Bleeding on probing
• Clinical attachment loss
• Decayed, missing, filled tooth indexing
Aarhus University
Aarhus University
 Bedside Oral Examination (BOE)
• Modified from the oral assessment guide (OAG)
• Scores: 8 to 24
 8-10: Excellent oral health
 11-14: Moderate impaired oral health
 15-24: Significantly impaired oral health
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03-09-2015
Aarhus University
Aarhus University
 Microbiological examination
 Results
• Saliva
• No significant effect of smoking or alcohol
consumption on oral health
• Trachesotomy secretions
• Brushing frequency related to severity and extent
(P<0.03)
• Swab from posterioir 1/3 of tongue
• Dentist appointment related to periodontal severity
(P=0.02)
• All patients were diagnosed with chronic generalized
periodontitis (P<0.001)
Aarhus University
 Results
• Correlation between BOE and severity of
periodontitis (P<0.01)
• Patient age group was significantly related to poor
oral health
Aarhus University
 Discussion
• Assessment of oral health: Beyond traditional
clinical markers
• Need to perform comprehensive oral health
assessment including all possible measures
 Higher BOE score (P=0.01)
• All evaluated ABI had chronic generalized
periodontitis: enhanced oral health care
 Extent and severity of periodontitis was higher
(P<0.02)
• Association between periodontitis and systemic
disease (Cerebro vascular, endocarditis, stroke)
Aarhus University
 Discussion
• BOE provides a narrative and visual reference, useful
tool to reinforce and sustain the assessment practice
• Older population shows relation between oral
health and systemic disease as well as QOL
Aarhus University
 Conclusion
Most of the recent literature demands to perform a
structured and validation study involving all available
tools for comprehensive oral health assessment in a
larger patient based population
• Access to professional oral health care is not limited
to “Rx per se” but also to the motivation and
instructions to the patients
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03-09-2015
Aarhus University
Aarhus University
 Future Plans
 Acknowledgement
• Standardized Assessment criteria of clinical oral
health status, behavioral and microbiological
outcomes are required to confirm oral health
disparities
•
Professor Jørgen Felbæk Nielsen, MD, PhD, Dr Med.
Hammel Neurorehabilitation and University Research Clinic, Hammel, Denmark
•
Mette Skjærbæk Svane, Occupational Therapist
Early Intensive Care Unit, Hammel Neurorehabilitation and University Research
Clinic, Hammel, Denmark
•
Rubens Spin-Neto, BDS, PhD
Section of Oral Radiology, School of Dentistry, Aarhus University, Denmark
MOHIT
(Mouth and Oral Hygiene Indexing and Treatment plan)
0 week/ 2 week
• Mouth and Oral Hygiene Indexing
• Treatment plan
Aarhus University
Thank you
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