Oral health education in cardiac rehabilitation: a randomised controlled trial of face-to-face and digital interventions

Despite the evidence supporting an association between oral disease and cardiovascular disease (CVD), oral health as a modifiable risk factor for cardiovascular health is rarely addressed. This randomised clinical trial (1:1:1) evaluated whether oral health education improves oral hygiene behaviours and knowledge of individuals attending cardiac rehabilitation. Three interventions were compared: individualised oral hygiene instruction (OHI) combined with a digital oral health education (DOHE) package, DOHE alone, or usual care: no oral health education. The primary outcome was improvement in oral hygiene, assessed by the approximal plaque index (API) at 6 weeks. Secondary outcomes included API reductions at 12 weeks, as well as self-reported changes in oral hygiene behaviours, knowledge, confidence, status, and motivation. A total of 158 participants were randomised (mean age 62 (11) years; 82.3% males). At 6 weeks, 77.1% (27/35) of participants receiving OHI + DOHE showed a reduction in API, compared to 26.8% (11/51) receiving usual care (odds ratio [OR] 9.16, 95% CI: 3.34–27.75). Participants receiving DOHE alone showed similar reductions. High participant acceptability of the digital materials, together with supportive feedback from cardiac nursing staff, underpins the feasibility of this approach. Oral health education delivered during cardiac rehabilitation using digital media alone, or in combination with clinician-delivered face-to-face messaging, shows evidence of initiating behavioural changes and is a scalable model for integrating oral health promotion into existing frameworks (Trial registration: Registered with anzctr.org.au, May 2nd, 2023: ACTRN12623000449639p).