{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T11:10:38Z","timestamp":1782385838949,"version":"3.54.5"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Oral Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Stroke is a serious cerebrovascular disease and is one of the world\u2019s leading causes of disability. Maintaining good oral health is a challenge among those hospitalised after stroke. A multidisciplinary approach to oral care involving non-dental professionals can be beneficial in improving oral health outcomes for patients. The aim of this study was to understand the perceptions of stroke survivors regarding oral healthcare across acute and rehabilitation settings.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A descriptive qualitative approach was used. Face-to-face semi-structured interviews were conducted. A framework analysis was employed to analyse the data. Patients who had recently experienced a stroke were purposively recruited across both acute and rehabilitation settings, at two metropolitan hospitals in Sydney, Australia. In total, 11 patients were interviewed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Although participants recognised the importance of oral health, few understood the link between oral and general health. Regular oral hygiene practices varied since having stroke, with a few receiving oral care assistance from nurses. Time, cost and lack of information were some barriers to accessing dental services, while supportive measures such as coordination of oral care, financial subsidy and nurse assistance were strategies proposed to support oral care practices amongst stroke survivors.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>There is scope to improve current models of oral care in stroke. While stroke survivors understand the importance of oral care, an integrated oral health model with a multidisciplinary approach could improve health outcomes.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12903-021-01501-7","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T12:03:06Z","timestamp":1615982586000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Patient perceptions of oral health care following stroke: a qualitative study"],"prefix":"10.1186","volume":"21","author":[{"given":"Shilpi","family":"Ajwani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caleb","family":"Ferguson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariana C.","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy R.","family":"Villarosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajesh","family":"George","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"issue":"25","key":"1501_CR1","doi-asserted-by":"publisher","first-page":"2429","DOI":"10.1056\/NEJMoa1804492","volume":"379","author":"GBD The","year":"2018","unstructured":"The GBD. 2016 lifetime risk of stroke collaborators: global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. N Engl J Med. 2018;379(25):2429\u201337.","journal-title":"N Engl J Med"},{"issue":"5","key":"1501_CR2","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1016\/S1474-4422(19)30034-1","volume":"18","author":"CO Johnson","year":"2019","unstructured":"Johnson CO, Nguyen M, Roth GA, Nichols E, Alam T, Abate D, Abd-Allah F, Abdelalim A, Abraha HN, Abu-Rmeileh NME, et al. Global, regional, and national burden of stroke, 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):439\u201358.","journal-title":"Lancet Neurol"},{"key":"1501_CR3","unstructured":"The economic impact of stroke in Australia [https:\/\/www2.deloitte.com\/content\/dam\/Deloitte\/au\/Documents\/Economics\/deloitte-au-economic-impact-stroke-australia-010313.pdf]"},{"issue":"49","key":"1501_CR4","doi-asserted-by":"publisher","first-page":"35","DOI":"10.7748\/ns2012.08.26.49.35.c9233","volume":"26","author":"H Dickinson","year":"2012","unstructured":"Dickinson H. Maintaining oral health after stroke. Nurs Stand. 2012;26(49):35\u20139.","journal-title":"Nurs Stand"},{"key":"1501_CR5","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1038\/vital847","volume":"5","author":"A Gopal","year":"2008","unstructured":"Gopal A. Stroke and oral health. Vital. 2008;5:40\u20132.","journal-title":"Vital"},{"key":"1501_CR6","unstructured":"Dickinson H: Improving the evidence base for oral assessment in stroke patients. University of Central Lancashire; 2016."},{"issue":"6","key":"1501_CR7","doi-asserted-by":"publisher","first-page":"520","DOI":"10.2340\/16501977-1806","volume":"46","author":"OLT Lam","year":"2014","unstructured":"Lam OLT, McMillan AS, Li LSW, McGrath C. Predictors of oral health-related quality of life in patients following stroke. J Rehabil Med. 2014;46(6):520\u20136.","journal-title":"J Rehabil Med"},{"issue":"1","key":"1501_CR8","first-page":"26","volume":"68","author":"B Clayton","year":"2012","unstructured":"Clayton B. Stroke, dysphagia and oral care: What is best practice? Alberta Assoc Regist Nurses. 2012;68(1):26\u20137.","journal-title":"Alberta Assoc Regist Nurses"},{"issue":"1","key":"1501_CR9","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1007\/PL00021290","volume":"16","author":"L Perry","year":"2001","unstructured":"Perry L, Love CP. Screening for dysphagia and aspiration in acute stroke: a systematic review. Dysphagia. 2001;16(1):7\u201318.","journal-title":"Dysphagia"},{"key":"1501_CR10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jcomdis.2016.07.003","volume":"63","author":"J Seedat","year":"2016","unstructured":"Seedat J, Penn C. Implementing oral care to reduce aspiration pneumonia amongst patients with dysphagia in a South African setting. S Afr J Commun Disord. 2016;63:1.","journal-title":"S Afr J Commun Disord"},{"issue":"3","key":"1501_CR11","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1046\/j.1532-5415.2002.50106.x","volume":"50","author":"T Yoneyama","year":"2002","unstructured":"Yoneyama T, Yoshida M, Ohrui T, Mukaiyama H, Okamoto H, Hoshiba K, Ihara S, Yanagisawa S, Ariumi S, Morita T, et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc. 2002;50(3):430\u20133.","journal-title":"J Am Geriatr Soc"},{"issue":"11","key":"1501_CR12","doi-asserted-by":"publisher","first-page":"2124","DOI":"10.1111\/j.1532-5415.2008.01926.x","volume":"56","author":"P Sj\u00f6gren","year":"2008","unstructured":"Sj\u00f6gren P, Nilsson E, Forsell M, Johansson O, Hoogstraate J. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc. 2008;56(11):2124\u201330.","journal-title":"J Am Geriatr Soc"},{"issue":"4","key":"1501_CR13","first-page":"231","volume":"48","author":"A Petroianni","year":"2006","unstructured":"Petroianni A, Ceccarelli D, Conti V, Terzano C. Aspiration pneumonia. Pathophysiological aspects, prevention and management. A review. Panminerva Med. 2006;48(4):231\u20139.","journal-title":"Panminerva Med"},{"issue":"4","key":"1501_CR14","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1007\/s00455-010-9298-9","volume":"25","author":"CC Pace","year":"2010","unstructured":"Pace CC, McCullough GH. The association between oral microorgansims and aspiration pneumonia in the institutionalized elderly: review and recommendations. Dysphagia. 2010;25(4):307\u201322.","journal-title":"Dysphagia"},{"issue":"7599","key":"1501_CR15","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1136\/bmj.39136.528160.BE","volume":"334","author":"EY Chan","year":"2007","unstructured":"Chan EY, Ruest A, Meade MO, Cook DJ. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ. 2007;334(7599):889.","journal-title":"BMJ"},{"issue":"2","key":"1501_CR16","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1097\/01.CCM.0000253395.70708.AC","volume":"35","author":"MP Chlebicki","year":"2007","unstructured":"Chlebicki MP, Safdar N. Topical chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. Crit Care Med. 2007;35(2):595\u2013602.","journal-title":"Crit Care Med"},{"issue":"3","key":"1501_CR17","doi-asserted-by":"publisher","first-page":"R155","DOI":"10.1186\/cc10285","volume":"15","author":"C Pileggi","year":"2011","unstructured":"Pileggi C, Bianco A, Flotta D, Nobile CGA, Pavia M. Prevention of ventilator-associated pneumonia, mortality and all intensive care unit acquired infections by topically applied antimicrobial or antiseptic agents: a meta-analysis of randomized controlled trials in intensive care units. Crit Care. 2011;15(3):R155.","journal-title":"Crit Care"},{"issue":"5","key":"1501_CR18","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1001\/jamainternmed.2014.359","volume":"174","author":"M Klompas","year":"2014","unstructured":"Klompas M, Speck K, Howell MD, Greene LR, Berenholtz SM. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA Intern Med. 2014;174(5):751\u201361.","journal-title":"JAMA Intern Med"},{"issue":"1","key":"1501_CR19","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1111\/joor.12229","volume":"42","author":"C Kwok","year":"2015","unstructured":"Kwok C, McIntyre A, Janzen S, Mays R, Teasell R. Oral care post stroke: a scoping review. J Oral Rehabil. 2015;42(1):65\u201374.","journal-title":"J Oral Rehabil"},{"issue":"4","key":"1501_CR20","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1177\/2396987318775206","volume":"3","author":"M Lyons","year":"2018","unstructured":"Lyons M, Smith C, Boaden E, Brady MC, Brocklehurst P, Dickinson H, Hamdy S, Higham S, Langhorne P, Lightbody C, et al. Oral care after stroke: Where are we now? Eur Stroke J. 2018;3(4):347\u201354.","journal-title":"Eur Stroke J"},{"issue":"7\u20138","key":"1501_CR21","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1111\/jocn.13520","volume":"26","author":"S Ajwani","year":"2017","unstructured":"Ajwani S, Jayanti S, Burkolter N, Anderson C, Bhole S, Itaoui R, George A. Integrated oral health care for stroke patients\u2014a scoping review. J Clin Nurs. 2017;26(7\u20138):891\u2013901.","journal-title":"J Clin Nurs"},{"issue":"6","key":"1501_CR22","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1177\/1474515119886798","volume":"19","author":"C Ferguson","year":"2019","unstructured":"Ferguson C, George A, Villarosa AR, Kong AC, Bhole S, Ajwani S. Exploring nursing and allied health perspectives of quality oral care after stroke: a qualitative study. Eur J Cardiovasc Nurs. 2019;19(6):505\u201312.","journal-title":"Eur J Cardiovasc Nurs"},{"key":"1501_CR23","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1111\/jocn.12665","volume":"24","author":"M Horne","year":"2015","unstructured":"Horne M, McCracken G, Walls A, Tyrrell PJ, Smith CJ. Organisation, practice and experiences of mouth hygiene in stroke unit care: a mixed-methods study. J Clin Nurs. 2015;24:728\u201338.","journal-title":"J Clin Nurs"},{"issue":"3","key":"1501_CR24","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1161\/01.STR.0000258355.23810.c6","volume":"38","author":"JL Banks","year":"2007","unstructured":"Banks JL, Marotta CA. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007;38(3):1091\u20136.","journal-title":"Stroke"},{"issue":"1","key":"1501_CR25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2307\/2137284","volume":"36","author":"RM Andersen","year":"1995","unstructured":"Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1\u201310.","journal-title":"J Health Soc Behav"},{"issue":"2","key":"1501_CR26","first-page":"72","volume":"4","author":"A Srivastava","year":"2009","unstructured":"Srivastava A, Thomson SB. Framework analysis: a qualitative methodology for applied policy research. JOAAG. 2009;4(2):72\u20139.","journal-title":"JOAAG"},{"issue":"1","key":"1501_CR27","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1080\/10749357.2019.1656413","volume":"27","author":"LN Zeng","year":"2020","unstructured":"Zeng LN, Rao WW, Luo SH, Zhang QE, Hall BJ, Ungvari GS, Chen LG, Xiang YT. Oral health in patients with stroke: a meta-analysis of comparative studies. Top Stroke Rehabil. 2020;27(1):75\u201380.","journal-title":"Top Stroke Rehabil"},{"issue":"10194","key":"1501_CR28","first-page":"188","volume":"394","author":"T Lancet","year":"2019","unstructured":"Lancet T. Oral health at a tipping point. Lancet. 2019;394(10194):188.","journal-title":"Lancet"},{"issue":"3","key":"1501_CR29","doi-asserted-by":"publisher","first-page":"E10","DOI":"10.1097\/JCN.0000000000000388","volume":"32","author":"P Sanchez","year":"2017","unstructured":"Sanchez P, Everett B, Salamonson Y, Ajwani S, George A. Oral healthcare and cardiovascular disease: a scoping review of current strategies and implications for nurses. J Cardiovasc Nurs. 2017;32(3):E10\u201320.","journal-title":"J Cardiovasc Nurs"},{"issue":"2","key":"1501_CR30","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1038\/s41415-019-0529-7","volume":"227","author":"S El-Yousfi","year":"2019","unstructured":"El-Yousfi S, Jones K, White S, Marshman Z. A rapid review of barriers to oral healthcare for vulnerable people. Br Dent J. 2019;227(2):143\u201351.","journal-title":"Br Dent J"},{"issue":"1","key":"1501_CR31","doi-asserted-by":"publisher","first-page":"28","DOI":"10.4037\/ajcc2007.16.1.28","volume":"16","author":"CL Cason","year":"2007","unstructured":"Cason CL, Tyner T, Saunders S, Broome L. Nurses\u2019 implementation of guidelines for ventilator-associated pneumonia from the Centers for Disease Control and Prevention. Am J Crit Care. 2007;16(1):28\u201336.","journal-title":"Am J Crit Care"},{"issue":"7","key":"1501_CR32","doi-asserted-by":"publisher","first-page":"e0181189","DOI":"10.1371\/journal.pone.0181189","volume":"12","author":"P Sanchez","year":"2017","unstructured":"Sanchez P, Everett B, Salamonson Y, Ajwani S, Bhole S, Bishop J, Lintern K, Nolan S, Rajaratnam R, Redfern J, et al. Oral health and cardiovascular care: perceptions of people with cardiovascular disease. PLoS ONE. 2017;12(7):e0181189.","journal-title":"PLoS ONE"},{"issue":"5","key":"1501_CR33","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1111\/j.1754-4505.2005.tb01654.x","volume":"25","author":"JM Chalmers","year":"2005","unstructured":"Chalmers JM, Pearson A. A systematic review of oral health assessment by nurses and carers for residents with dementia in residential care facilities. Spec Care Dentist. 2005;25(5):227\u201333.","journal-title":"Spec Care Dentist"}],"container-title":["BMC Oral Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-021-01501-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12903-021-01501-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-021-01501-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T12:04:35Z","timestamp":1615982675000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcoralhealth.biomedcentral.com\/articles\/10.1186\/s12903-021-01501-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,17]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1501"],"URL":"https:\/\/doi.org\/10.1186\/s12903-021-01501-7","relation":{},"ISSN":["1472-6831"],"issn-type":[{"value":"1472-6831","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,17]]},"assertion":[{"value":"4 November 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The investigation conforms with the principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Sydney Local Health District Human Research Ethics Committee (X16-0067). All participants provided informed consent prior to participation. Carers were approached for informed consent for patients who were eligible but had an mRS of 5, but were not considered to be in a life-threatening state, intubated, or in a state where they were to be transferred into a nursing home following discharge.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All participants or their carers provided consent for publication of the data collected. All individual data has been de-identified to ensure confidentiality.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Dr Caleb Ferguson is supported by a 2018 Postdoctoral Research Fellowship (Ref.: 102168) from the National Heart Foundation of Australia. All other authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"127"}}