Oral care and stroke units.

OBJECTIVE: To investigate oral care provision reported by senior nurses in stroke care settings in Scotland. BACKGROUND: Stroke can have adverse effects on oral care and health. Little is known about current oral care practices in stroke care settings. MATERIALS AND METHODS: We designed a postal survey to be completed by ward managers or senior nurses. After piloting, the survey was distributed to all 71 units in Scotland, identified as providing specialist care for patients in the acute or rehabilitation stages following stroke. Pre-notification and reminder letters were circulated. Responses were anonymous. RESULTS: All but one survey was completed and returned. Help from dental professionals was available to most units (64/70) mostly on request. Only a third of units received oral care training in the last year (23/ 70). The majority of this training was ward based (20/23). The use of oral care assessment tools and protocols was limited (16/70 and 15/70 units respectively). Not all units had access to toothbrushes, toothpaste or chlorhexidine. For patients unable to perform oral care independently, senior nurses expected the patients' teeth or dentures to be cleaned at least twice a day in 59 of 70 and 49 of 70 units respectively. CONCLUSION: The response rate was excellent and has provided a national overview of oral care provision for patients in stroke care settings. Access to staff training, assessments, protocols and oral hygiene material varied considerably. This information provides a valuable baseline from which to develop and evaluate the effectiveness of ward-based oral care interventions for stroke patients.

Alzheimer's disease and oral care.

Alzheimer's disease (AD) is the commonest form of dementia, closely associated with age, but also with other causative factors. AD affects half a million people in the UK, and presents dentists with numerous behavioural and clinical challenges. The aetiology, diagnosis and medical treatment for persons with AD are discussed, together with communication strategies and issues related to families and care-givers. Realistic dental treatment planning for patients in early, moderate and late stage AD is considered in conjunction with relevant ethical issues. Dentists have the potential to improve markedly the quality of life for people with AD.

Oral health care education and its effect on caregivers' knowledge and attitudes: a randomised controlled trial.

OBJECTIVES: The effect of an oral health care education programme (OHCE) upon nursing home caregivers was assessed in a randomised controlled trial. METHODS: A self-administered questionnaire assessed oral health care knowledge and attitudes at baseline among 369 caregivers working in 22 nursing homes. Homes were randomly allocated to two groups. The intervention was a workplace OHCE. Caregivers assessed the value of the presentations. Questionnaires were re-administered 1 month (time 2) and 6 months (time 3) after the OHCE was delivered. The knowledge and attitude score means of the groups were compared. Open-ended questions solicited qualitative data. RESULTS: Questionnaire response rates at the three time points ranged from 76.3% to 85.4%. Two-thirds of caregivers employed at the time of the intervention attended the presentations. The OHCE was favourably assessed in 79% of responses. The intervention group significantly improved their scores over the control group at times 2 and 3 for knowledge (P<0.003) and attitude (P<0.001). Analysed across both arms at baseline, the main predictors for knowledge and attitude scores were age and dental attendance pattern. Qualitative responses showed an acceptance of caregivers' roles in oral health care and criticism of existing provision within homes. CONCLUSIONS: The OHCE was well received and resulted in improved oral health care knowledge and attitudes. When viewed with separately reported trial results of clients' oral health status, knowledge and attitude score improvements coincided with improved delivery of oral health care.