Effects of power toothbrushing on oral inflammation, caregiver adherence, and systemic inflammation in a sample of nursing home residents
Date
2015-04-16
Authors
Lavigne, Salme E
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Abstract
Title: “Effects of Power Toothbrushing on Oral Inflammation, Caregiver Adherence, and Systemic Inflammation in a Sample of Nursing Home Residents”
Objectives: The aims of this study were to investigate whether twice daily use of a rotating–oscillating power toothbrush (Oral-B Professional Care 1000 ™) in nursing home (NH) residents over a six-week period of time, as compared to usual care, would: (1) reduce oral inflammation; (2) increase caregiver adherence with oral care; and (3) reduce systemic inflammation.
Methods: In this repeated measures single-blinded randomized controlled trial, 59 residents of one nursing home in Winnipeg, Canada, were randomized to receive either twice daily tooth brushing with a rotating-oscillating power toothbrush (PB) or usual care (UC) by caregivers. Consent was obtained from residents directly or from their proxies. Participants had some natural teeth; oral inflammation; non- aggressive behaviour; no communicable diseases; were non-smokers; and were non-comatose. Outcomes were recorded at baseline and 6 weeks, which included oral inflammation (MGI, Lobene), bleeding (PBI, Loesche), and Plaque (Turesky); systemic inflammation (hsC-reactive Protein, hsCRP) and caregiver adherence (self-reported twice daily toothbrushing). Caregivers completed a survey at study end regarding their oral care delivery preference. Group specific changes in oral outcomes and caregiver adherence were analyzed using a General Linear Model with a repeated measure. Changes in hsCRP were analyzed using non-parametric statistical tests, given challenges with the variance in these data. Survey results were analyzed using descriptive statistics.
Results: Of the 59 original study participants, one withdrew and one died prior to initial data collection, and three individuals died before study completion. Oral health parameters improved significantly for the remaining 54 residents over time, (p< 0.0001) however equally for residents in each study group. HsCRP did not change significantly over time, overall or between residents in either study group. During all weeks combined, caregiver adherence was similar between study groups (40% for UC, 42% for PB). Caregiver adherence reduced significantly, from week 1 (48.6%) to week 6 (37.4%), with no significant differences between groups. Caregivers stated a preference for the power toothbrush (69%), and 78% reported it was easier to use than a regular brush.
Conclusions: This study provides unique evidence about NH caregiver adherence to providing oral care for a sustained period of time. Despite this however, using as outcomes direct measures of inflammation, the oral health of NH residents improved significantly, albeit equally in both study groups. Given this disjoint in results, further studies are required to investigate improved methods for measuring caregiver adherence to the provision of daily oral care for NH residents.
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Keywords
oral, health, caregiver, adherence, inflammation, power toothbrush