{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T01:08:37Z","timestamp":1788829717593,"version":"build-2803163510"},"reference-count":41,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Oral Rehabilitation"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Individuals with dysphagia exhibit impaired oral clearance and reduced airway protection, increasing oral biofilm accumulation and inflammatory burden.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate whether a structured, individualized oral care approach (MOHIT) was associated with changes in oral inflammatory and biofilm\u2010related markers in dysphagic, care\u2010dependent individuals with acquired brain injury (ABI) during inpatient neurorehabilitation.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Adults with ABI, who screened positive for dysphagia at week 1 (\n n<\/jats:italic>\n \u2009=\u200944) were followed for 3\u2009weeks in an exploratory predefined subgroup analysis of a cluster nonrandomized controlled trial. Three wards implemented a structured, individualized oral care protocol (MOHIT:\n n<\/jats:italic>\n \u2009=\u200912), consisting of structured oral assessment and individualized nurse\u2010delivered oral care including suction\u2010assisted electric toothbrushing, while three wards continued standard oral care (EOCP:\n n<\/jats:italic>\n \u2009=\u200932). 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\u2010of\u2010change indicators were compared using the Mann\u2013Whitney\n U<\/jats:italic>\n test.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Toothbrushing frequency did not differ between groups (\n p<\/jats:italic>\n \u2009=\u20090.347). The MOHIT group showed more favourable exploratory changes in overall mBOE score (3.1\u2009\u00b1\u20092.2 vs. 0.8\u2009\u00b1\u20092.8;\n p<\/jats:italic>\n \u2009=\u20090.007), bleeding on probing (22.7\u2009\u00b1\u200922.3 vs. \u22124.0\u2009\u00b1\u200920.2;\n p<\/jats:italic>\n \u2009=\u20090.001), plaque (20.1\u2009\u00b1\u200914.0 vs. 2.7\u2009\u00b1\u200917.4;\n p<\/jats:italic>\n \u2009=\u20090.009), and odour score (1.6\u2009\u00b1\u20091.7 vs. 0.3\u2009\u00b1\u20091.4;\n p<\/jats:italic>\n \u2009=\u20090.019). Tongue\u2010coating score showed a favourable but non\u2010significant exploratory pattern (6.2\u2009\u00b1\u20095.5 vs. 1.4\u2009\u00b1\u20096.6;\n p<\/jats:italic>\n \u2009=\u20090.057).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Structured, individualized oral care delivered by trained nursing staff was associated with improvements in screening and clinical inflammatory markers among dysphagic, care\u2010dependent ABI individuals. Given the cluster\u2010level implementation, small sample size, and nonrandomized allocation, findings indicate feasibility and support hypothesis\u2010generating evidence of potential clinical benefit but do not establish causal efficacy.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/joor.70299","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:55:26Z","timestamp":1788828926000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Individualized Oral Health Care for Dysphagic, Care\u2010Dependent Patients With Acquired Brain Injury: An Exploratory Predefined Subgroup Analysis of a Cluster Nonrandomized Controlled Trial"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8191-9769","authenticated-orcid":false,"given":"Mohit","family":"Kothari","sequence":"first","affiliation":[{"name":"Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine Aarhus University Hammel Denmark"},{"name":"Department of Clinical and Preventive Odontology, Faculty of Health Sciences University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"issue":"2","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.jdent.2014.06.005","article-title":"A Systematic Review and Meta\u2010Analysis of Clinical, Microbiological, and Behavioural Aspects of Oral Health Among Patients With Stroke","volume":"43","author":"Dai R.","year":"2015","journal-title":"Journal of Dentistry"},{"issue":"1","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000484989","article-title":"Oral Health and Brain Injury: Causal or Casual Relation?","volume":"8","author":"Pillai R. 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F.","year":"2021","journal-title":"Frontiers in Neurology"},{"key":"e_1_2_12_9_1","article-title":"Staff\u2010Led Interventions for Improving Oral Hygiene in Patients Following Stroke","volume":"4","author":"Brady M.","year":"2006","journal-title":"Cochrane Database of Systematic Reviews"},{"issue":"4","key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1111\/j.1440-172X.2010.01861.x","article-title":"Defining the Fundamentals of Care","volume":"16","author":"Kitson A.","year":"2010","journal-title":"International Journal of Nursing Practice"},{"key":"e_1_2_12_11_1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s12912-020-00457-3","article-title":"Nurses' Attitude Towards Oral Care and Their Practicing Level for Hospitalized Patients in Orotta National Referral Hospital, Asmara\u2010Eritrea: A Cross\u2010Sectional Study","volume":"19","author":"Dagnew Z. 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C.Fr\u00f8lund M. \u00d8.Klit L.Ladegaard et\u00a0al. \u201cKlinisk Retningslinje\u2014Mundhygiejne Til Voksne Borgere og Patienter [Clinical Guideline\u2014Oral Hygiene for Adult Citizens and Patients] \u201d(2021)."},{"key":"e_1_2_12_16_1","volume-title":"National Clinical Guideline for Stroke for the UK and Ireland","year":"2023"},{"issue":"3","key":"e_1_2_12_17_1","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1111\/j.1834-7819.2005.tb00360.x","article-title":"The Oral Health Assessment Tool\u2014Validity and Reliability","volume":"50","author":"Chalmers J. M.","year":"2005","journal-title":"Australian Dental Journal"},{"issue":"3","key":"e_1_2_12_18_1","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1111\/joor.13285","article-title":"Internal Structure and Validity of the Bedside Oral Examination Tool in Patients With Brain Injury at Neurorehabilitation Setting","volume":"49","author":"Kothari S. F.","year":"2022","journal-title":"Journal of Oral Rehabilitation"},{"issue":"9","key":"e_1_2_12_19_1","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1080\/02699052.2020.1795720","article-title":"Oral Health: Something to Worry About in Individuals With Acquired Brain Injury?","volume":"34","author":"Kothari S. 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Y.","year":"2007","journal-title":"BMJ"},{"issue":"1","key":"e_1_2_12_30_1","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1159\/000440733","article-title":"Risk of Stroke\u2010Associated Pneumonia and Oral Hygiene","volume":"41","author":"Wagner C.","year":"2016","journal-title":"Cerebrovascular Diseases"},{"key":"e_1_2_12_31_1","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1111\/joor.70170","article-title":"Evidence\u2010Based Mouth and Oral Health Individualised Treatment Plan in Adults With Acquired Brain Injury: A Cluster Nonrandomized Controlled Trial","volume":"53","author":"Kothari M.","year":"2026","journal-title":"Journal of Oral Rehabilitation"},{"issue":"3","key":"e_1_2_12_32_1","first-page":"193","article-title":"Musculoskeletal Orofacial Pain and Other Signs and Symptoms of Temporomandibular Disorders During Pregnancy: A Prospective Study","volume":"19","author":"LeResche L.","year":"2005","journal-title":"Journal of Orofacial Pain"},{"issue":"3","key":"e_1_2_12_33_1","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1177\/0269215513500057","article-title":"Randomized Trial of Two Swallowing Assessment Approaches in Patients With Acquired Brain Injury: Facial\u2010Oral Tract Therapy Versus Fibreoptic Endoscopic Evaluation of Swallowing","volume":"28","author":"Kjaersgaard A.","year":"2014","journal-title":"Clinical Rehabilitation"},{"issue":"4","key":"e_1_2_12_34_1","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1177\/0269215515584381","article-title":"A Validation Study of the Facial\u2010Oral Tract Therapy Swallowing Assessment of Saliva","volume":"30","author":"Mortensen J.","year":"2016","journal-title":"Clinical Rehabilitation"},{"issue":"5","key":"e_1_2_12_35_1","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.iccn.2013.04.001","article-title":"The Bedside Oral Exam and the Barrow Oral Care Protocol: Translating Evidence\u2010Based Oral Care Into Practice","volume":"29","author":"Prendergast V.","year":"2013","journal-title":"Intensive & Critical Care Nursing"},{"issue":"6","key":"e_1_2_12_36_1","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1111\/j.1365-2842.2007.01733.x","article-title":"New Method for Evaluation of Tongue\u2010Coating Status","volume":"34","author":"Shimizu T.","year":"2007","journal-title":"Journal of Oral Rehabilitation"},{"issue":"1","key":"e_1_2_12_37_1","doi-asserted-by":"crossref","DOI":"10.1088\/1752-7155\/8\/1\/017102","article-title":"Organoleptic Assessment of Halitosis for Dental Professionals\u2014General Recommendations","volume":"8","author":"Greenman J.","year":"2014","journal-title":"Journal of Breath Research"},{"key":"e_1_2_12_38_1","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12970-017-0185-8","article-title":"Salivary Diagnostic Markers in Males and Females During Rest and Exercise","volume":"14","author":"Rutherfurd\u2010Markwick K.","year":"2017","journal-title":"Journal of the International Society of Sports Nutrition"},{"key":"e_1_2_12_39_1","doi-asserted-by":"crossref","DOI":"10.3389\/fresc.2024.1337920","article-title":"Impaired Oral Health: A Required Companion of Bacterial Aspiration Pneumonia","volume":"5","author":"Ashford J. 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