Original article Oral care and stroke units Ana Talbot 1 , Marian Brady 2 , Denise L.C. Furlanetto 2 , Heather Frenkel 3 and Brian O. Williams 1 1 Care of the Elderly Department, Gartnavel General Hospital, Glasgow, UK; 2 Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK; 3 Dental Postgraduate Department, Bristol Dental Hospital, Bristol, UK Gerodontology 2005; 22; 77–83 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 spe- cialist 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. Keywords: cerebrovascular accident, oral hygiene, oral health, questionnaire. Accepted 15 November 2004 Introduction For a variety of related reasons stroke can adversely affect oral care. Physical impairment, co-ordina- tion, sensory or cognitive deficits may accompany a stroke and can impact on independent oral care 1 . Post-stroke alterations in facial muscle mass or movement and sensory problems may result in poorly controlled dentures. Dysphagia can contribute to oral care concerns in a number of ways. Oral intake of fluids may be restricted to reduce the risk of aspiration pneu- monia, which in turn can contribute to xerostomia. Nutritional supplements, often prescribed, are high in sugar and may predispose to caries. Further- more, because of swallowing impairment, phar- macological interventions are often administered in syrup consistency, which is sugar based, and may also predispose to caries. Reduced swallowing ability causes ineffective clearance of bacteria and debris from the mouth leading to caries and infec- tion 2 . Some pharmacological interventions in stroke care are known to have oral side effects. Oxygen therapy frequently administered in acute stroke management is known to cause mucosal drying and blistering 3 . Absence of normal chewing pat- terns as a result of pain, physical or sensory impairment can also reduce salivary function. Xerostomia also causes pain, taste disturbance, chewing 4 and swallowing difficulties 2 . Speech and denture retention are also effected by inadequate saliva 5 . This in turn increases plaque formation 2 , predisposes to opportunistic oral infections 6 , Ó 2005 The Gerodontology Association and Blackwell Munksgaard Ltd, Gerodontology 2005; 22: 77–83 77