Individualized Oral Health Care for Dysphagic, Care-Dependent Patients With Acquired Brain Injury: An Exploratory Predefined Subgroup Analysis of a Cluster Nonrandomized Controlled Trial.

BACKGROUND

Individuals with dysphagia exhibit impaired oral clearance and reduced airway protection, increasing oral biofilm accumulation and inflammatory burden.

OBJECTIVE

To evaluate whether a structured, individualized oral care approach (MOHIT) was associated with changes in oral inflammatory and biofilm-related markers in dysphagic, care-dependent individuals with acquired brain injury (ABI) during inpatient neurorehabilitation.

METHODS

Adults with ABI, who screened positive for dysphagia at week 1 (n = 44) were followed for 3 weeks in an exploratory predefined subgroup analysis of a cluster nonrandomized controlled trial. Three wards implemented a structured, individualized oral care protocol (MOHIT: n = 12), consisting of structured oral assessment and individualized nurse-delivered oral care including suction-assisted electric toothbrushing, while three wards continued standard oral care (EOCP: n = 32). Outcomes included behavioural indicators (brushing frequency and toothbrush type), modified Bedside Oral Examination (mBOE), and clinical parameters (plaque, bleeding on probing, tongue coating, and odour) assessed at baseline and week 4. Direction-of-change indicators were compared using the Mann-Whitney U test.

RESULTS

Toothbrushing frequency did not differ between groups (p = 0.347). The MOHIT group showed more favourable exploratory changes in overall mBOE score (3.1 ± 2.2 vs. 0.8 ± 2.8; p = 0.007), bleeding on probing (22.7 ± 22.3 vs. -4.0 ± 20.2; p = 0.001), plaque (20.1 ± 14.0 vs. 2.7 ± 17.4; p = 0.009), and odour score (1.6 ± 1.7 vs. 0.3 ± 1.4; p = 0.019). Tongue-coating score showed a favourable but non-significant exploratory pattern (6.2 ± 5.5 vs. 1.4 ± 6.6; p = 0.057).

CONCLUSION

Structured, individualized oral care delivered by trained nursing staff was associated with improvements in screening and clinical inflammatory markers among dysphagic, care-dependent ABI individuals. Given the cluster-level implementation, small sample size, and nonrandomized allocation, findings indicate feasibility and support hypothesis-generating evidence of potential clinical benefit but do not establish causal efficacy.