Introduction: The aim of this study was to evaluate the levels of C-reactive protein (CRP) and interleukin-6 (IL-6) in the gingival crevicular fluid (GCF) among stroke survivors in relation to the oral hygiene status and stroke characteristics. Methods: A multi-centre cross-sectional study was conducted among hospitalised stroke survivors. Socio-demographic data were collected. Oral clinical assessment (dental plaque scores) and functional dependency levels scores were carried out. Gingival Crevicular Fluids were collected, using absorbent papers and analysed using ELISA kit. Descriptive statistic and correlation analyses were performed using proportion and Spearmen correlation coefficient test. Results: A total of 53 patients were recruited from five public hospitals. There was a significant correlation between CRP and IL-6 levels of GCF (P=0.021, r=0.21). A significant correlation was also observed between CRP levels in GCF with dental plaque scores and functional dependency levels. There was no statistically significant correlation found between IL-6 levels in GCF with dental plaque scores and functional dependency levels. Dental plaque scores were associated with high levels of CRP in GCF (P=0.014), and swallowing problem was associated with high levels of IL-6 in GCF (P=0.002). Conclusions: IL-6 levels in GCF were correlated with the levels of CRP in GCF. High CRP and IL-6 levels in GCF were significantly associated with dental plaque scores and swallowing condition (presence of dysphagia), respectively. Thus, this pilot study suggests that CRP level in the oral cavity respond to the oral health conditions and may not be a predictor factor of stroke outcomes. Further studies are warranted to compare the level of inflammatory biomarkers from the oral cavity and serum in relation to the stroke conditions and outcomes.

Background Oral hygiene care is of key importance among stroke patients to prevent complications that may compromise rehabilitation or potentially give rise to life-threatening infections such as aspiration pneumonia. Objective The aim of this study was to evaluate the effectiveness of a Web-based continuing professional development (CPD) program on general intention of the health carers to perform daily mouth cleaning for stroke patients using the theory of planned behavior (TPB). Methods A double-blind cluster randomized controlled trial was conducted among 547 stroke care providers across 10 hospitals in Malaysia. The centers were block randomized to receive either (1) test intervention (a Web-based CPD program on providing oral hygiene care to stroke patients using TPB) or (2) control intervention (a Web-based CPD program not specific to oral hygiene). Domains of TPB: attitude, subjective norm (SN), perceived behavior control (PBC), general intention (GI), and knowledge related to providing oral hygiene care were assessed preintervention and at 1 month and 6 months postintervention. Results The overall response rate was 68.2% (373/547). At 1 month, between the test and control groups, there was a significant difference in changes in scores of attitude (P=.004) and subjective norm (P=.01), but not in other TPB domains (GI, P=.11; PBC, P=.51; or knowledge, P=.08). At 6 months, there were significant differences in changes in scores of GI (P=.003), attitude (P=.009), SN (P<.001) and knowledge (P=.001) between the test and control groups. Regression analyses identified that the key factors associated with a change in GI at 6 months were changes in SN (beta=.36, P<.001) and changes in PBC (beta=.23, P<.001). Conclusions The Web-based CPD program based on TPB increased general intention, attitudes, subjective norms, and knowledge to provide oral hygiene care among stroke carers for their patients. Changing subjective norms and perceived behavioral control are key factors associated with changes in general intention to provide oral hygiene care.

Computer-aided learning (CAL) offers enormous potential in disseminating oral health care information to patients and caregivers. The effectiveness of CAL, however, remains unclear. Objectives: The purpose of this study was to systematically review published evidence on the effectiveness of CAL in disseminating oral health care information to patients and caregivers. Materials and Methods: A structured comprehensive search was undertaken among 7 electronic databases (PUBMED, CINAHL Plus, EMBASE, SCOPUS, WEB of SCIENCE, the Cochrane Library, and PsycINFO) to identify relevant studies. Randomized controlled trials (RCTs) and observational studies were included in this review. Papers were screened by 2 independent reviewers, and studies that met the inclusion criteria were selected for further assessment. Results: A total of 2915 papers were screened, and full texts of 53 potentially relevant papers (kappa = 0.885) were retrieved. A total of 5 studies that met the inclusion criteria (1 RCT, 1 quasi-experimental study, and 3 postintervention studies) were identified. Outcome measures included knowledge, attitude, behavior, and oral health. Significant improvements in clinical oral health parameters (P<. 05) and knowledge/attitudes (P<. 001) were reported in 2 of the studies. The 3 remaining studies reported improved oral health behaviors and confidence. Conclusion: There is a limited number of studies which have examined the effectiveness of CAL interventions for oral health care among patients and caregivers. Synthesis of the data suggests that CAL has positive impacts on knowledge, attitude, behavior, and oral health. Further high-quality studies on the effectiveness of CAL in promoting oral health are warranted.

Objectives: This study aimed to examine "intention to" and "performance of" oral hygiene care to stroke patients using the Theory of Planned Behavior. Materials and methods: A large scale survey of 13 centers in Malaysia was conducted involving 806 nurses in relation to oral hygiene care intentions and practices. In addition, information on personal and environmental factors was collected. Results: The response rate was 95.6% (778/806). The domains of the Theory of Planned Behavior were significantly associated with general intention to perform oral hygiene care: attitudes (beta = 0.21, p < 0.001), subjective norms (b = 0.38, p < 0.001), perceived behavior control (b = 0.04, p < 0.001); after controlling for personal and environmental factors. Approximately two-thirds (63.4%, 493) reported the performance of some form of oral hygiene care for patients. This behavior was associated with general intention scores (OR = 1.13, 95% CI = 1.05-1.22, p < 0.01), controlling for other factors. Knowledge scores, training, access to oral hygiene guidelines and kits, as well as working ward type were identified as key factors associated with intention and practice of oral hygiene care. Conclusion: The Theory of Planned Behavior provides understanding of "intention to" and "performance of" oral hygiene care to stroke patients. Several provider and environmental factors were also associated with intentions and practices. This has implications for understanding and improving the implementation of oral hygiene care in stroke rehabilitation.