title: A systematic review and meta-analysis of clinical, microbiological, and behavioural aspects of oral health among patients with stroke.
abstract: OBJECTIVE
  The objective of this study was to review clinical, microbiological, and immunological aspects of oral health, as well as oral health related behaviours among patients following stroke.
  
  
  METHODS
  A structured search strategy was applied to three electronic databases to identify relevant papers.
  
  
  METHODS
  The initial search yielded 19,927 papers, 60 potentially relevant studies (Kappa: 0.974) and 23 relevant papers (Kappa: 0.965) in accordance with the inclusion criteria. Outcomes regarding tooth condition, periodontal condition, oral hygiene status, and dental attendance were pooled for seven meta-analyses. Narrative summaries were provided for those outcomes which could not be pooled for meta-analysis.
  
  
  RESULTS
  The standardized differences in mean values of the parameters (fixed effect, random effect model) for patients with stroke compared to control groups were: number of teeth (-0.325, -0.271), DMFT (0.246, 0.246), oral hygiene status - plaque index (0.305, 0.356) and gingival index (0.716, 0.653), periodontal health status - clinical attachment loss (0.437, 0.490) and probing depth (0.470, 0.579). In addition, a lower chance of dental attendance was observed among patients with stroke (odds ratio: 0.493, 0.480). For those outcomes which could not be pooled for meta-analysis, it was not possible to draw any qualitative conclusion due to the equivocal results of these studies.
  
  
  CONCLUSIONS
  There is an increasing interest in oral health of patients with stroke. Patients with stroke had a poorer clinical oral health status across a range of parameters (tooth loss, dental caries experience, and periodontal status). Coupled with this, their dental attendance was less frequent. Further studies employing standardized assessments of oral health/oral health behaviour can confirm these oral health disparities.
  
  
  CONCLUSIONS
  With comprehensive literature search, this systematic review and meta-analysis indicated a poorer oral health status and less frequent dental attendance behaviour among patients with stroke.
authors: Department of Periodontology and Public Health, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital 3/F, 34 Hospital Road, Sai Ying Pun, Hong Kong, China.
authors: Ruoxi
authors: R
authors: Dai
authors: Department of Oral Rehabilitation, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital 4/F, 34 Hospital Road, Sai Ying Pun, Hong Kong, China.
authors: Otto L T
authors: OL
authors: Lam
authors: Department of Periodontology and Public Health, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital 3/F, 34 Hospital Road, Sai Ying Pun, Hong Kong, China.
authors: Edward C M
authors: EC
authors: Lo
authors: Department of Rehabilitation Medicine, Tung Wah Hospital, 12 Po Yan Street, Sheung Wan, Hong Kong, China.
authors: Leonard S W
authors: LS
authors: Li
authors: Department of Periodontology and Public Health, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital 3/F, 34 Hospital Road, Sai Ying Pun, Hong Kong, China.
authors: Yifeng
authors: Y
authors: Wen
authors: Department of Periodontology and Public Health, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital 3/F, 34 Hospital Road, Sai Ying Pun, Hong Kong, China. Electronic address: mcgrathc@hkucc.hku.hk.
authors: Colman
authors: C
authors: McGrath
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D003731:Dental Caries / Q000150:complications*; D005881:Gingiva / Q000473:pathology; D015438:Health Behavior; D006801:Humans; D016017:Odds Ratio; D009909:Oral Health; D009910:Oral Hygiene; D010519:Periodontium / Q000473:pathology*; D020521:Stroke / Q000150:complications / Q000276:immunology / Q000382:microbiology* / Q000523:psychology*; D016388:Tooth Loss / Q000150:complications*
chemical_list: D015415:Biomarkers
keywords: Meta-analysis; Observational studies; Oral health; Stroke; Systematic review