Commentary

This systematic review covers an area where there is very little evidence of good practice. The oral health of older people in general, and of stroke patients in particular, is an area that has been somewhat neglected in the past. It is now receiving more interest in Scotland, particularly as a result of the National Dental Action Plan (formulated in 2005), which identifies older people as a priority group for dental care. The fact that this systematic review was only able to identify one paper that showed data from before and after an oral care intervention for people who had suffered a stroke indicates the lack of research evidence in the field. The study showed that just 1 h of training for care staff on oral health procedures resulted in a significant improvement in staff knowledge of and attitudes towards oral health, and denture cleanliness. This was maintained even several months after the training, which was encouraging given the high staff turnover in the care sector. The study failed to show any improvement in intra-oral care, however, indicating that this is an area which many care staff still feel is not a priority. Further research will be required to identify the reasons for this.

Many dental staff have been involved in ad hoc training of care staff in the past, and there is a need to develop high-quality, evidence-based packages for this purpose. There is work ongoing in this area, but in the meantime, it is clear from this study that training of care staff can increase their oral health awareness. Any subsequent improvements in oral health will benefit the stroke patient, particularly with regard to speech, nutrition, systemic health and quality of life. On the basis of the study reported here, any input given by dental personnel to care staff might well reap benefits far beyond the oral cavity, and dental staff should be encouraged to work with other healthcare colleagues in a multidisciplinary way to achieve the necessary level of oral health input.