Literature Review Assesses Impact of Oral Health Education on Patients in Cardiology Hospital Settings

Cardiovascular disease (CVD) is widely recognized as the leading cause of death worldwide. Many modifiable risk factors are well known, such as smoking status, dietary choices, alcohol intake, and sedentary lifestyle.¹

However, oral health status is a lesser-known risk factor for cardiovascular disease. This potential lack of awareness may be because oral health education is traditionally delivered in a dental setting, and less than half of the world’s population visits the dentist regularly. Therefore, many don’t get this important message.¹

Numerous barriers, including cost and accessibility, impede access to dental care, reinforcing the need to expand oral hygiene care and education into broader health care settings. Research demonstrates that providing oral hygiene care in hospitals reduces non-ventilator hospital-acquired pneumonia and shortens hospital stays. While nurses currently manage oral care in these settings, they often face challenges. Accordingly, integrating dental professionals would offer a more effective solution.¹

A literature review aimed to identify and describe the impact of oral health education delivered to patients with CVD in cardiology hospital wards and outpatient clinics.¹

The Review

Electronic databases were searched for literature through May 7, 2024. Inclusion criteria included adults 18 years of age or older with a recent hospitalization because of cardiovascular disease who had traditional oral health education in a hospital setting or outpatient clinic.¹

Twenty-three studies were assessed for eligibility, with only three being eligible and included in this review. Two included studies were randomized controlled trials, and the third was a quasi-randomized controlled trial. In total, the three studies included 245 participants. The studies took place in Hong Kong or Japan between 2013 and 2019.¹

Educational interventions used in the studies included oral hygiene instructions delivered by dental professionals. Follow-up times differed between studies, ranging from three weeks to six months.¹

The Results

All three studies reported a lack of regular oral hygiene at baseline, which improved after the study. All studies reported improved toothbrushing habits, and one reported a significant increase in the use of interdental brushes. Improved periodontal parameters and tongue coating scores with significant reductions in plaque scores were found in all study arms.¹

Improvements in oral health also positively impacted postoperative health outcomes in the included studies, such as a reduction or absence of common CVD postoperative complications. Common complications such as pneumonia and atrial fibrillation can lengthen hospital stays or lead to premature death.¹

Although good oral hygiene is associated with reduced systemic inflammation, none of the included studies evaluated inflammatory markers such as C-reactive protein and interleukin 6.¹

Despite the association between oral health and cardiovascular disease, this review determined that oral health education is rarely provided in hospitals or outpatient clinics.¹

Conclusion

Preventing poor oral health starts with efforts to improve oral health education. Implementing oral health education in health care settings beyond dental settings could positively affect at-risk patients, ultimately improving their overall health.¹

Integrating dental professionals within health care settings could help bridge the gap in implementing oral hygiene care and education programs. It could also help ease the burden on nurses who may not have the time or training to provide this care and education.¹

There were limitations to the review, including the small number of eligible studies. The studies included were limited to Hong Kong and Japan, which may not be a good representation of patients with cardiovascular disease globally.¹

Nonetheless, a strength was that this is the first known review to evaluate oral health education programs provided to patients in a hospital setting or outpatient clinical care after a cardiovascular event.¹

The review concluded that there is a need for further development and evaluation of oral health education programs in hospital settings or outpatient clinical care. Oral hygiene significantly improved when oral health education was delivered directly to patients, which minimized the risk of postoperative pneumonia and lessened the number of postoperative days with atrial fibrillation.¹

Integrating dental professionals and implementing oral health education as part of postoperative care instructions could improve health outcomes for patients who experience cardiac events.¹

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Reference

1. Church, L.A., Robins, L., Xu, F., et al. Oral Health Education Strategies for Patients Living with Cardiovascular Disease within Hospital Settings: A Scoping Review. Front Public Health. 2024; 12: 1389853. https://pmc.ncbi.nlm.nih.gov/articles/PMC11220159/