Evidence‐Based Mouth and Oral Health Individualised Treatment Plan in Adults With Acquired Brain Injury: A Cluster Nonrandomized Controlled Trial

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Abstract
Objective: Oral health care (OHC), despite its essential role in overall health, remains underprioritized in medical practice. The study investigated the effectiveness of an individualised, item‐specific, Mouth and Oral Health Individualised Treatment (MOHIT) plan compared to the existing oral care plan (EOCP) in individuals with acquired brain injury (ABI). Methods: A cluster nonrandomized controlled trial was conducted across six wards at a neurorehabilitation center. Wards were pragmatically assigned to deliver either MOHIT or routine EOCP for 3 weeks. Based on stepwise oral assessment, the MOHIT plan provided individualised protocols tailored to each patient's dependency level and oral condition. Oral care was performed daily by trained nurses under dental supervision. The primary outcome was change in bleeding on probing (BOP) from baseline to Week 4. Secondary outcomes included plaque index, tongue coating, oral malodor, salivary flow rate, and modified Bedside Oral Examination (mBOE) total and sub‐scores. Linear mixed‐effects models (for continuous outcomes) and cumulative link mixed models (for ordinal outcomes) were applied to assess Week‐4 versus baseline changes between groups, adjusting for ward clustering, baseline values, age, sex, and feeding status. Results: 86/126 individuals completed the trial (34 MOHIT, 52 EOCP). Compared with EOCP, the MOHIT plan showed greater reductions in BOP (coeff: −19.11; 95% CI: −27.97 to −10.24) and significant improvements in plaque (−13.23; 95% CI: −19.93 to −6.53), tongue coating (−3.01; 95% CI: −5.58 to −0.45), oral malodor (−1.27; 95% CI: −2.15 to −0.40), and suspected oral candidiasis (−3.21; 95% CI: −3.22 to −3.20) compared with EOCP. MOHIT also showed greater improvement in mBOE scores (−1.46; 95% CI: −2.54 to −0.39). Effects remained consistent after sensitivity analyses controlling for baseline imbalance and missing data. Conclusion: An individualised, item‐specific, nurse‐implemented OHC plan guided by structured screening and clinical assessment improved gingival inflammation and oral hygiene compared with routine care in adults with ABI within a multidisciplinary neurorehabilitation setting. Validation and feasibility testing in randomised clinical trials are warranted to facilitate translation into clinical practice.

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