One-year compliance and effects of amine and stannous fluoride on some salivary biochemical constituents and oral microbes in institutionalized elderly

Due to old age and poor general health, the institutionalized elderly have often not been used as research subjects for the investigation of oral health protocols. Because the number of elderly is increasing, they are an important target group for the development of oral hygiene aids. This trial was designed to investigate whether the institutionalized elderly could succesfully use an amine‐fluoride‐ and stannous‐fluoride‐containing mouthwash and toothpaste during a 12‐month period. A dental hygienist visited the subjects weekly, instructed them, and recorded their self‐reported compliance. Plaque and saliva samples were taken at three‐month intervals. Some salivary biochemical constituents reflecting mucosal integrity were analyzed. The carrier status of Actinobacillus actinomycetem comitans, Porphyromonas gingivalis, Bacteroides forsythus, Prevotella intermedia, and Prevotella nigrescens was studied by the polymerase chain‐reaction method, and acidogenic bacteria and yeasts by dip‐slide methods (Orion Diagnostica, Espoo, Finland). Of those 98 subjects originally included, 44 elderly (30 women and 14 men; mean age, 81.7 ± 5.9 yrs) completed the trial. Their observations were positive or very positive regarding the use of mouthwash and toothpaste. The number of residents with P. gingivalis decreased statistically significantly throughout the trial, while the carrier status of the other periodontal bacteria and mutans streptococci remained on the same level. The number of subjects with high counts (≥ 10⁵ cfu/mL) of yeasts decreased during the study: 26.2% at baseline, 9.1% one year later, respectively. Biochemical analyses of salivary immunoglobulins showed no effect on IgA and IgM levels, but IgG reduced significantly. Albumin and other salivary protein concentrations were found to have a decreasing tendency. Thus, the overall effect of the protocol was beneficial with regard to subjects' oral health as measured in this study. The residents were pleased to participate, but the number of drop‐outs was very high, confirming the expected difficulties with the utilization of a group of frail elderly as research subjects.