ประสิทธิผลของการดูแลสุขภาพช่องปากในผู้ป่วยโรคหลอดเลือดสมองที่มีภาวะกลืนลำบาก

Abstract

Dysphagia, commonly found in stroke patients, impacts oral health care and increases the risk of dental problems such as dental caries, gum disease, tongue coating, and the risk of pneumonia from aspiration. Stroke patients with dysphagia should receive comprehensive care from interdisciplinary teams, including dental professionals. This study was a quasi-experimental assessment of the effectiveness of an oral health care program for stroke patients undergoing swallowing rehabilitation. The objectives were to study oral health status and functions in stroke patients and compare the outcomes of the program in dysphagia therapy. Data were analyzed using descriptive and analytical statistics. The sample consisted of 46 randomly selected patients from the stroke rehabilitation ward of Chiang Mai Neurological Hospital, Chiang Mai, Thailand, from June 2022 to July 2023. The control group received routine daily oral care, while the intervention group followed program recommendations, such as tongue brushing before swallowing therapy. Data collection included general information, oral health status, oral function (oral health, tongue movement, and tongue pressure), swallowing severity levels, nasogastric feeding duration, and oral comfort levels. The results of this study show that both groups improved their ability to swallow. However, the intervention group had a statistically significant reduction in nasogastric tube removal rate compared to the control group (7.8 ± 2.9 vs. 10.6 ± 4.2 days, p<0.05). Additionally, the intervention group showed significant differences in tongue coating index (57.5 ± 15.2 vs 76.8 ± 9.3, p<0.05), diadochokinesis "ka" (3.4 ± 0.3 vs 3.2 ± 0.3 times/second, p<0.05), tongue pressure (15.6 ± 5.0 vs 11 ± 3.8 kPa, p<0.05), and oral comfort, between groups. This study demonstrates that the oral health care program effectively enhances oral function and reduces the nasogastric tube removal rate for stroke patients in swallowing rehabilitation. Therefore, dental professionals and other healthcare personnel should recommend suitable oral care programs for these patients.