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Oral MedicineDental care of stroke patients

Discussion.Although no evidence-based clinical den-tal nof atthe lytho epa o-vid ssred d.As alma tswiBackground.The risk of recurrent stroke is higheramong persons who have suffered a stroke or a transient is-chemic attack (TIA), as compared with the risk of the firststroke. This increased risk may remain for a maximum of1 year after the stroke or TIA, with as many as 70% of recur-rent episodes occurring within 1 month. It has been recom-mended, on the basis of this increased risk, that electivedental care should be delayed for a minimum of 6 monthsafter a stroke, TIA, or reversible ischemic neurologic defect.However, studies now show that the risk for recurrent cere-brovascular (CrbV) events is only partly the result of cardio-vascular (CV) causes, with most of the risk related topulmonary complications associated with aspiration.Thus, the risk for CV complications of dental treatment isnot as elevated as previously thought, and adequate oralfunction to prevent aspiration events is vital. These conclu-sions do not support postponing dental treatment as theguidelines suggest for patients who have experienceda stroke or TIA. The risk for developing ischemic CrbV com-plications after dental treatment in patients who had a CrbVinsult within the previous year was assessed in a retrospec-tive observational comparative study.

Methods.The two study groups consisted of 16 pa-tients who had experienced a CrbV event within the 12months before dental treatment and 25 patients who hadischemic CV disease. All patients were treated accordingto the stress reduction protocol, which involved establish-ing good rapport, having an appointment at the conve-nience of the patient, and encouraging patients toexpress their anxiety or fear. Patients were monitoredboth during and after having dental treatment. The param-eters of the treatment and the outcomes were analyzed.

Results.All the patients in the CrbV group underwentdental treatment without incident. One patient in the CVgroup had transient local mental neuropathy that persistedfor 4 weeks after dental treatment. Patients in the CrbVgroup tended to have longer durations of treatment thanthose in the CV group. About 75% of the CrbV patientsand all the CV patients underwent dental treatment underlocal anesthesia. None of the patients required either tran-quilizers or anxiolytic medications. The CrbV group hadslightly higher blood pressure values than the CV group,but the difference did not reach statistical significance.Clinical Significance.The poor oral hygieneof patients discharged from the hospital afterstroke could be exacerbated if dental treatmentis withheld for another 6 months for fear of re-current stroke. Stroke survivors need to be ableto chew adequately and swallow food withoutdifficulty so as to avoid developing aspirationpneumonia. The benefits associatedwith restor-ing patients to good oral health seem to greatlyoutweigh the risk of recurrent stroke demon-strated in this study.

Elad S, Zadik Y, Kaufman E, et al: A new management approach fordental treatment after a cerebrovascular event: A comparativeretrospective study. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 110:145-150, 2010

Reprints available from S Elad, Dept of Oral Medicine, HebrewUniv-Hadassah School of Dental Medicine, POB 12272, Jerusalem91120, Israel; e-mail: eladhome@md.huji.ac.ilguidelines are currently in place regarding the provisiodental care for stroke patients, this study suggests thrisk of recurrent stroke is far less than it was previousught. Rather than wait for 6 months or a year to help thtient regain oral health, it seems to make sense to pre the required dental care in an atmosphere where streuction techniques and careful monitoring are practicelong as patients are under medical surveillance, dentnagement can be undertaken for poststroke patienthin weeks of the event.One of the CrbV patients had isolated controlled hyperten-sion; the rest of the patients had good to moderatelybalanced blood pressure values. None of the patients takingwarfarin had values outside of the therapeutic range. Inva-sive dental procedures were performed in 68.8% of theCrbV group but none of the CV group. Overall, patients tol-erated the dental treatment well, with hemostasis achievedusing local hemostatic means. None of the patients devel-oped CrbV adverse events within a month of treatment.Volume 56 Issue 5 2011 243

Dental care of stroke patients Background Methods Results Discussion