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

BACKGROUND: 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.