Effectiveness of the "CEME" oral health intervention program for preventing stroke-associated pneumonia in patients with post-stroke dysphagia: a randomized controlled trial

BMC Oral Health. 2025 Dec 4;25(1):1870. doi: 10.1186/s12903-025-07190-w.

Abstract

Background: Pneumonia is common among post-stroke dysphagia (PSD) patients, especially in the week following a stroke; pneumonia may prolong hospital stays or lead to mortality. We examined whether a tailored "CEME" (oral cleaning, oral motor exercises, Chinese acupoint and salivary gland massage, and safe-swallowing education) oral health intervention program could improve swallowing function and oral health and reduce the incidence of stroke-associated pneumonia (SAP) in PSD patients.

Methods: We conducted an assessor-blinded randomized controlled trial in a tertiary hospital in China. Eighty-four PSD patients were recruited and randomly assigned to either the control group (n = 42) or the experimental group (n = 42). The control group received conventional oral care, whereas those in the experimental group participated in the "CEME" oral health intervention program, which included oral cleaning, oral motor exercises, Chinese acupoint and salivary gland massage, and safe-swallowing education. Outcome measures were conducted on day 7 of the implementation of the intervention, including stroke-associated pneumonia incidence, swallowing function (measured via the Water Swallowing Test (WST) and the Functional Oral Intake Scale [FOIS]), overall oral health (measured via the Oral Health Assessment Tool [OHAT]), salivary secretion status (measured via the modified Schirmer test [MST]), oral hygiene status (measured via the Plaque Index [PI]), and stroke severity (assessed via the National Institute of Health Stroke Scale [NIHSS]).

Results: The incidence of SAP in the experimental group was 10.26% (4/39), lower than the corresponding figure in the control group of 32.43% (12/37) (P < 0.05); furthermore, the WST grades, OHAT scores, and Plaque Index exhibited by the experimental group were better than the control group (P < 0.05). No significant differences were observed in FOIS grades, MST or NIHSS scores (P > 0.05).

Conclusion: The tailored CEME intervention effectively reduced SAP incidence in PSD patients while concomitantly improving oral health and water swallowing function.

Trial registration: ChiCTR2300074510, registered on August 08, 2023.

Keywords: Intervention; Oral health; Post-stroke dysphagia; Stroke; Stroke-associated pneumonia.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • China
  • Deglutition
  • Deglutition Disorders* / complications
  • Deglutition Disorders* / etiology
  • Deglutition Disorders* / therapy
  • Female
  • Humans
  • Male
  • Massage
  • Middle Aged
  • Oral Health*
  • Oral Hygiene* / methods
  • Pneumonia* / etiology
  • Pneumonia* / prevention & control
  • Pneumonia, Aspiration* / etiology
  • Pneumonia, Aspiration* / prevention & control
  • Stroke Rehabilitation
  • Stroke* / complications