Improving Dental Hygiene in Stroke Patients

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Following a cerebrovascular accident (CVA) or stroke, patients have many challenges as they recover. Speech, memory, and mobility issues in the aftermath of a CVA are quite common, and increasingly sophisticated therapies have been designed to assist in treating them. But one health issue that’s been neglected in the past is the CVA patient’s oral health. After all, brushing and flossing would not seem to require a great deal of mental or physical effort. But as health care providers have discovered, it’s not as easy for CVA patients to provide basic dental hygiene for themselves as one might think.

Dental Hygiene Difficulties For CVA Patients

In the aftermath of a stroke, patients may have difficulty manipulating their facial muscles, important for properly chewing and swallowing food. As a result, there is an increased risk of choking on insufficiently chewed food. Because muscles tend to be weaker on one side of the body following a stroke, CVA patients may experience food pocketing when attempting to feed themselves.

Unable to use facial muscles to direct food, it builds up in interior cheek folds on one side of the face. “Food debris” can be drawn into the lungs, leading to pneumonia. Less serious, but still detrimental to oral health, this “stored” food can lead to gum disease and tooth decay, if teeth and gums are exposed to this retained food for prolonged periods of time. Because of muscle weakness and facial insensitivity, CVA patients are often unaware that they are pocketing food.

In the past, CVA caregivers both at home and institutional settings were given little guidance here, except for the recommendation to puree food for easier swallowing. But consumption of food in such a form has been shown to increase dental plaque, creating another set of oral hygiene problems.

Suggested Dental Hygiene Care For CVA Patients

Physical therapy for CVA patients should include swallowing techniques, and exercising tongue muscles to allow patients to sweep food from inner cheeks on both sides of the face and swallow it. Teeth, gums, and the interior of the mouth should be frequently monitored by dental health care professionals, both to clean it and check for problems the CVA patient might not be able to sense. For caretakers who must assist with brushing and flossing, they should stand directly behind the patient, cupping the chin in one hand, and brushing in a circular motion.

For CVA patients able to participate in their own oral health care, there are numerous options. For patients with aspiration difficulties, a suction toothbrush is available. If patients have gripping issues, they may want to use a child’s toothbrush with its softer handle, or a power one, as its larger handle can be easier to hold. If a patient is having problems with fine motor control, then a three headed toothbrush, able to reach larger surface areas, may be more effective than a standard one.

And while toothpaste can be used, only prescription paste is recommended, and patients should be trained to spit it out without swallowing any. And both patients and caregivers should remember that many stroke medications lead to xerostomia or dry mouth, and this lack of saliva can lead to both swallowing difficulties and tooth decay. This can be avoided with frequent hydration, and using humidifiers.

Nadia Kiderman is a dentist based out of New York City.

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