Stroke – Oral Health Implications

A Stroke is the result of the blood supply to the brain being disrupted. The arteries carrying blood to the brain may become blocked by plaque or a blood clot or they may rupture (Stroke Foundation, 2007). Stroke is one of the top three causes of death worldwide with more than 700,000 Americans and 40,000 Australians suffering from one each year and more than 150,000 passing away as a result (Libby, P et.al, 2008 & Brain Foundation, 2011). There are a higher proportion of women who suffer from Stroke compared to only 40% of whom are men and this disease mainly affects minority groups (Libby, P et.al, 2008).

There are two main ways that a Stroke can occur.

Ischaemic stroke (blocked artery)

The most common form of Stroke is known as an Ischaemic Stroke (Brain Foundation, 2011). This occurs from a blockage in the artery that is carrying blood to part of the brain. Blockages can occur in two ways; either by a blot cot that has formed somewhere else in the body that travels to the brain where it is too large to pass through the arteries, this is known as Embolic Stroke or by Thrombotic Stroke which is caused by build-up of cholesterol ‘plaque’ that narrows the size of the artery (Stroke Foundation, 2007). If blood supply to any part of the brain ceases for more than a few minutes, that specific part of the brain stops functioning and brain tissue begins to die. (Brain Foundation, 2011). As a result, if the blockage is not cleared, the whole part of the brain that the particular artery supplies, may die. This is often called brain infarction (Brain Foundation, 2011).

Haemorrhagic stroke (bleed in the brain)

Also known as cerebral haemorrhage, this kind of Stroke occurs a result of a blood vessel rupturing within the brain or into the space around the brain (Brain Foundation, 2011). Due to the high pressure inside the artery, as it bursts, it also tears the brain tissue, resulting in a large clot that ultimately puts pressure on the brain and can cause brain death. (Brain Foundation, 2011).

Symptoms of Stroke

Everyone is affected differently; however symptoms of stroke usually come on very suddenly. (Brain Foundation, 2011). Common warning signs include sudden numbness of the face, arm or leg on one side of the body, dizziness , loss of balance, confusion, trouble communicating and walking, blurred vision and headaches (Brain Foundation, 2011 & Stroke Association, 2011). Some people affected my symptoms such as nausea, vomiting, drowsiness or seizures, although such symptoms are rarer (Brain Foundation, 2011).

In 2006, a campaign to increase awareness of the common warning signs of Stroke was established to help prevent delayed reaction and improve the outcomes of sufferers (Stroke Foundation, 2011). This is known as FAST, referring to the face, the arms, speech and time (Stroke Foundation, 2011). This campaign aims to teach people in the general community to act fast if they witness signs and symptoms such as, a drooped face, inability to lift arms and or slurred speech (Stroke Foundation, 2011).

Effects on Oral Health

The after effects of a Stroke can be both challenging and demanding for patients in regards to the whole body but in particular, the health and maintenance of the oral cavity.

One of the general health effects of a Stroke is paralysis on one side of the body (Colgate, 2011). Paralysis is defined as being “an impairment or loss of the motor function of the nerves, causing immobility” (Anderson J, 2007, pg. 762). Such impairment could lead to a number of issues including, not being able to brush the teeth efficiently on the effected side, difficulties with rinsing of the mouth and not realising when food is left in the oral cavity (Colgate, 2011). If not monitored, this could ultimately lead to caries, gingivitis and or periodontal disease; however there are options available such as electric toothbrushes, floss holders and large interdental brushes to prevent such outcomes.

Image supplied by 21st century dental http://www.21stcenturydental.com/smith/education/ulcers.htm

Certain medications that are prescribed to Stroke victims can lead to a dry mouth, known as Xerostomia (Brady, M et.al, 2007). Side effects include a constant sore throat, difficulty communicating, impaired swallowing and dry nasal passages (Bartels C, 2000). Three out of ten patients with Xerostomia will result in gingivitis, periodontal disease or loss of tooth structure by erosion (Bartels C, 2000). If left untreated, Xerostomia will lower the pH within the mouth and increase the development of plaque and therefore dental caries (Bartels C, 2000). Treatment options include saliva substitutes such as GC Dry Mouth Gel or certain types of tablets that increase the quantity of saliva. Blood thinning medications can effect certain dental procedures including extractions and deep scaling (Colgate, 2011). Such medications may need to be stopped prior to these types of treatments and it is therefore vital that Stroke victims give oral health care providers up to date and accurate medical histories.

Another oral health effect of Stroke is ulcers of the mouth (Brady, M et.al, 2007). Although most ulcers are harmless and clear up by themselves, there can be a number of complications is left untreated including bacterial infection, inflammation of the mouth (cellulitis) or development of an abscess.

Denture Stomatitis is s fungal/yeast disease that leads to infection in the mouth (Better Health Victorian Government, 2011). The wearing of dentures may be compromised as a result of a Stroke and many dentures need to be adjusted in such circumstances (Colgate, 2011 & (Brady, M et.al, 2007). Denture Stomatitis can be caused by inadequately cleaned or ill-fitting dentures and such disease may need medication to rectify.

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