Plaque removal with an experimental chewable toothbrush and a control manual toothbrush in a care-dependent elderly population: a pilot study

OBJECTIVE: Oral hygiene and oral health are major concerns for care-dependent elderly persons. The objective of this study was to examine the plaque removal efficacy of a novel experimental chewable toothbrush used by the subjects themselves. METHODOLOGY: Fourteen subjects whose oral care was usually provided by caregivers in nursing facilities were enrolled in a two-phase, crossover study. The study was designed to evaluate plaque removal following a single brushing with either an experimental chewable toothbrush used by the subjects themselves, or a control manual toothbrush used by caregivers on the subjects. Plaque removal was assessed according to the plaque index of Silness and L?e. RESULTS: The overall plaque scores were significantly reduced from 2.14 +/- 0.53 to 1.23 +/- 0.39 using the experimental brush, and from 2.08 +/- 0.43 to 1.22 +/- 0.17 using the control brush (p < 0.05). Relative plaque reduction was 41.0 +/- 17.6% for the experimental brush group and 38.8 +/- 16.6% for the control brush group, with no significant difference between the two brushes (p = 0.84). On lingual tooth surfaces, the experimental brush showed a plaque reduction of 68.8 +/- 13.7% compared to 38.4 +/- 22.9% with the control brush, and the difference was statistically significant (p = 0.011). The chewable toothbrushes were harmless and acceptable to the subjects. CONCLUSION: The experimental brush was able to remove a significant amount of plaque, particularly on the lingual surfaces, demonstrating its effectiveness for plaque removal when used by care-dependent elderly.     

Efficacy of a sonic toothbrush for plaque removal by caregivers in a special needs population

Oral hygiene and oral health are a major concern for long-term-care facility residents who are unable to care for themselves. In this six-week study, the efficacy of a sonic toothbrush (Sonicare®) was compared with traditional manual brushing in a setting where hygiene care was provided by caregivers. Evaluations of plaque levels were made at baseline and at 2, 4, and 6 weeks according to the Silness and Löe index. The sonic brush was found to be significantly superior to the manual brush over the trial period (MANCOVA; p = 0.026). Plaque reduction at 6 weeks was found to be 38% with the sonic brush and 6% with the manual brush. The results indicate that the sonic brush may be an effective way to provide improved oral health to nursing home subjects when oral care is caregiver-provided.     

Oral hygiene care levels in Iowa intermediate care facilities

Oral hygiene care levels in lowa intermediate care facilities
This study was undertaken to improve understanding of current oral hygiene care practices in intermediate care facilities. Questionnaires were sent to directors of nursing of all licensed intermediate care facilities in Iowa. Results show that an estimated 57% of residents needed direct oral hygiene assistance. In all intermediate care facilities, the majority of direct oral hygiene care was provided by aides. Oral hygiene care was often not provided at an optimal level, and the main reasons reported for this lack of care were uncooperative residents (82%), lack of perceived need by aides (68%), and inadequate time/personnel(49%). Development and promotion of oral
hygiene care programs in intermediate care facilities must take into consideration the realities and problems involved. Otherwise, efforts to introduce or implement new or improved care programs will fail.     

Oral status, oral hygiene habits and caries risk factors in home-dwelling elderly dependent on moderate or substantial supportive care for daily living

Strömberg E, Hagman‐Gustafsson M‐L, Holmén A, Wårdh I, Gabre P. Oral status, oral hygiene habits and caries risk factors in home‐dwelling elderly dependent on moderate or substantial supportive care for daily living. Community Dent Oral Epidemiol 2011;. © 2011 John Wiley & Sons A/S Abstract – Objectives: Elderly people with disabilities have an increased risk of developing oral diseases as compared with the healthy elderly. The aim of this study was to investigate oral hygiene habits, clinical variables related to oral self‐care and caries risk in elderly individuals living at home with moderate and substantial needs of home care. Methods: A random sample of 151 elderly people with moderate needs and 151 with substantial needs of home care were examined. Data concerning general health, social conditions and oral hygiene habits were collected using a questionnaire. Data showing the prevalence of caries, plaque scores and gingival bleeding were obtained through clinical examinations. Results: Elderly subjects with substantial needs of home nursing had more active caries (P < 0.01) and more often gingival bleeding (P < 0.05), as compared with elderly people with moderate needs. Forty‐nine per cent of the elderly with moderate needs performed acceptable self‐care, as compared with 25% of the individuals with substantial needs. Good self‐care was associated with women, low plaque scores, less bleeding and less caries. Factors increasing the risk of having caries were low saliva secretion, high plaque scores and a large number of fillings, while having a dentist and good oral hygiene habits increased the chance of not developing caries. Conclusions: Good oral hygiene habits were associated with less prevalence of plaque and oral disease in the elderly irrespective of extent of needs of home nursing. However, the elderly with moderate needs more often performed good self‐care, indicating that the possibilities of strengthening self‐care and learning new routines are better when functions are less affected.     

Effectiveness of oral hygiene techniques on plaque and gingivitis in patients placed in intermaxillary fixation

Twenty-one patients undergoing reconstructive maxillofacial surgery volunteered to learn and practice specific oral hygiene techniques while in intermaxillary fixation in order to compare the effectiveness of different regimens. Oral irrigation was taught to all subjects; one third of the subjects were also instructed in the use of the sulcus brush, and another third were instructed in the use of the Perio-Aid. Scoring was done every 2 weeks for a 6-week period, with measurements taken of the amount of plaque and the amount of inflammation present in papillary, marginal, and attached gingiva. Results show that the group employing only the Water Pik had less inflammation in the attached gingiva than the group using the Perio-Aid and less plaque accumulation and papillary inflammation than the group using the sulcus brush. While more research is necessary to confirm these results, the simplest home care regimen, use of the Water Pik only, appears to offer the best way for intermaxillary fixation patients to remove plaque and minimize inflammation during convalescence.     

Long‐term effects of using oral care aides at a nursing home for elderly dependent residents—a pilot study

The oral health status of elderly dependent residents is reported to be poor, as well as difficult to describe. Analysis of oral microbial flora has been suggested as a suitable measurement method. Oral care aides have been shown to have a positive influence on oral health care in nursing. The outcome of an intervention with oral care aides was followed during a two‐year period by recording: (a) the proportion of opportunistic microorganisms and bacteria associated with caries (b) whether oral hygiene assistance were given to the residents or not, and (c) individual experiences concerning oral health care among the staff involved. The oral flora and the amount of oral hygiene assistance improved throughout the entire study period, but staff interviews revealed that it took two years for good cooperation and prophylactic routines to be established. An unexpected finding was the positive correlation (p = .0005) between a high proportion of the opportunistic microorganisms and death within one year.     

A clinical study to assess the ability of a powered toothbrush to remove chlorhexidine/tea dental stain

AIM: A single-center, single-blind, two-way crossover study was performed to compare the effects of an electric powered toothbrush with a conventional manual toothbrush at removing chlorhexidine/tea tooth staining. METHODS: This study used 24 subjects. During the week before the study, the subjects received a prophylaxis to remove all staining, plaque and calculus deposits. On the Monday of the following week, subjects returned to the clinic to receive a further prophylaxis. Under direct supervision, they then rinsed with a 0.2% chlorhexidine mouthrinse, immediately followed by a rinse with a warm black tea solution. This cycle was repeated hourly eight times throughout the day and on the following days until the Friday. Throughout this period, volunteers omitted all other forms of oral hygiene except rinsing with the chlorhexidine mouthwash. On the Friday, the level of stain was assessed both prior to and immediately after brushing with the allocated brush with toothpaste for 1 min. This was done in an adjoining room (out of sight of the clinical scorer). Subjects were then instructed to use the toothbrush at home according to their normal oral hygiene practices. On the following Friday, subjects returned to the clinic when the stain present was re-assessed. Each subject received a thorough prophylaxis to remove all plaque calculus and staining before starting the second period of the study and again on completion of the study. RESULTS: The study showed relatively little difference between the ability of the two brushes to remove stain at a single test brushing. However, there was some evidence that the powered brush was more effective than the manual brush in minimising stain level during the home use period, overall and in particular for gingival crescent sites. CONCLUSIONS: This study has suggested that the powered brush may become more effective at reducing dental stain, the longer the brush is used under normal home conditions.     

Use of a powered toothbrush for hygiene of edentulous implant-supported prostheses

Effective professional maintenance and personal oral hygiene are important for the long-term success and comfortable functioning of implant-assisted dental restorations. Incorporating the most effective oral hygiene devices into each patient's oral hygiene regimen facilitates optimal results. The use of a powered toothbrush with interchangeable brush heads permits effective cleaning of the most access-challenging prosthesis contours. This article presents a useful personal oral hygiene regimen for the long-term maintenance of various implant-supported dental restorations.     

A 3-month home use study comparing the oral hygiene and gingival health benefits of triclosan and conventional fluoride toothpastes

Abstract A number of triclosan toothpastes are available which have been shown to benefit gingival health when compared to triclosan free control formulations. There have been few studies to compare such active products with conventional fluoride toothpaste products. The aim of this study was to compare, in home use, a triclosan product with conventional fluoride products already found to show slightly less plaque inhibition in a short term plaque regrowth study. The study was a single-blind, parallel design with a total of 129 healthy dentate volunteers (32 male. 97 female) who toothbrushed with one of 4 toothpaste products at home, twice a day over a period of 12 weeks. At the beginning of the trial, each volunteer was scored for plaque and gingivitis and then received a thorough prophylaxis. Each volunteer was allocated a toothpaste according to a predetermined randomisation scheme. The volunteers were re-examined after 6 and 12 weeks. The volunteers refrained from using any other oral hygiene products during the period of the trial. The toothpastes tested were two conventional fluoride toothpastes, a children's fluoride toothpaste and a triclosan/copolymer toothpaste. Results indicated that there were no overall significant treatment differences for either plaque index or gingival index and ordering of toothpastes was not possible. All volunteers' oral hygiene and gingivitis improved following the 6-week period and continued to improve to the 12th week. This is a feature of most oral hygiene trials and presumably arises from the initial prophylaxis and a Hawthorne response of improved toothcleaning by the subjects. It must be concluded from this study that in normal home use the triclosan/copolymer toothpaste provides oral hygiene and gingival health benefits no greater than achievable with conventional toothpaste products.     

Comparison of a sonic and a manual toothbrush for efficacy in supragingival plaque removal and reduction of gingivitis

Abstract A new sonic electric toothbrush (Sonicare®) and a traditional manual toothbrush were compared for efficacy in removing supragingival plaque and reducing gingival inflammation in a 12-week, single-blind clinical trial. 60 subjects with a gingival index (GI) of >1.5 and no probing depths >5 mm were randomly assigned to use either the manual or sonic brush, instructed in its use, and asked to brush each morning and evening for 2 minutes. Plaque scores were taken at baseline and at 1.2, 4. and 12 weeks using the Turesky modification of the Quigley-Hein plaque index. Gingival inflammation was assessed by the GI. bleeding tendency score, presence or absence of bleeding on probing, volumetric measurements of gingival crevicular fluid (GCF). and aspartate aminotransferase (AST) levels in GCF. Repeated measures multivariate analyses of variance were used to delect time- and device-dependent differences for all clinical assessments between the 2 groups over the 5 visits. Both types of brush were effective in removing supragingival plaque. The sonic brush was statistically superior, on a percentage reduction basis, in removing supragingival plaque from the dentition taken as a whole (F-statistic; p=0.012) and was particularly better in hard-to-reach areas such as posterior teeth (F-statistic; p=0.003) and interproximal sites (F-statistic; p=0.004). Both devices were equally effective in reducing gingival inflammation. The sonic brush exhibited less tendency to cause gingival abrasion than the manual brush (1 incident with sonic, 5 incidents with manual), confirming the safely of this product as an oral hygiene device.     

Clinical evaluation of plaque removal with a double-headed toothbrush

Abstract A blind, two-way, crossover clinical trial, completed by 44 adult subjects, instructed in specific oral hygiene techniques, was carried out to compare the effectiveness of plaque removal between a new Scandinavian double-headed toothbrush and a popular single-headed brush, each used for one week. The results showed that the double-headed brush was significantly more effective in removing plaque overall than a conventional brush. The effect was most evident on all lingual surfaces, especially in the lower arch and molar regions. It was also particularly pronounced when the double-headed toothbrush was allocated for use in the 2nd week of the study. There was no significant difference in the cleaning ability of the 2 brushes on the buccal surfaces of the teeth.     

Attitudes and perceptions towards oral hygiene tasks among geriatric nursing home staff

To cite this article:
Int J Dent Hygiene 9 , 2011; 199–203
DOI:10.1111/j.1601‐5037.2010.00477.x Forsell M, Sjögren P, Kullberg E, Johansson O, Wedel P, Herbst B, Hoogstraate J. Attitudes and perceptions towards oral hygiene tasks among geriatric nursing home staff. Abstract: Objectives: To assess attitudes and perceptions towards oral hygiene tasks among geriatric nursing home staff, before and after a dental hygiene education. Methodology: A survey questionnaire was distributed to the nursing staff (n = 105), at a geriatric nursing home in Stockholm, Sweden. Results: The response rate to the questionnaire was 83%. A vast majority (87%) of the nursing staff considered oral hygiene tasks unpleasant. The main reason for considering oral care unpleasant was a perceived unwillingness from the residents. The perceived unwillingness from the residents among the nursing staff was reduced after the dental hygiene education (chi‐square test, P = 0.02). A vast majority of the nursing staff experienced, always or sometimes, resistance from the residents towards oral care. Conclusions: Nursing home staff members consider oral care tasks unpleasant, and frequently experience resistance from the nursing home residents towards oral care. The perceived unwillingness from the residents is reduced after an advanced dental hygiene education. Further studies are needed to evaluate the effects of education on nursing staff’s attitudes and perceptions towards oral care tasks, with the overall aim of improving the oral health among older people in hospitals and nursing homes.     

Efficacy and acceptance of professional dental cleaning among nursing home residents

Objectives

To determine the impact of general and oral health status of nursing home residents in Germany on efficacy and acceptance of professional dental cleaning performed by a dental nurse.

Materials and methods

Participants (N = 41; mean age 83 ± 8 years) living in a nursing home were included. Personal and general health, oral health, oral hygiene habits, and needs were investigated. Individual acceptance regarding professional dental cleaning via different devices (scaler, interdental brushes, ultrasonic cleaning) was assessed, as was the efficacy of this method using after-cleaning indices.

Results

Oral health among nursing home residents was impaired and independent from dementia status. Most residents (33/41) performed oral hygiene procedures independently and showed better index values than those in need of external help. Residents requiring help with oral hygiene showed increased risk profiles (higher age, more often immobile, demented, more xerostomia). The dental cleaning procedure required a mean time of 37 ± 11 min, was widely accepted (36/41), and achieved clean results (plaque index 0.1 ± 0.5, oral hygiene index 0.2 ± 1.6, Volpe-Manhold index 0.4 ± 1.6); food residues were reduced to 0 independent from cognitive status. Regarding the cleaning methods, scalers were accepted best without difference between demented and non-demented residents.

Conclusions

Professional dental cleaning in nursing homes is an accepted and efficacious oral hygiene procedure among nursing home residents.

Clinical relevance

Professional dental cleaning is an efficacious and accepted method as a first step in line with strategies to improve oral health and should be considered in nursing home residents.

     

Predictors of root caries in the elderly

In an attempt to determine the association between overall health status, medication history, and oral hygiene status and root caries, 24 older persons residing independently in the community and 23 residents of a nursing home were interviewed and received oral examinations, using the Oral Hygiene Index and the Root Caries Index. The mean age of this population was 80 yr, with the nursing home subjects somewhat older than community-dwelling subjects. Only six persons had no root surface caries; three subjects had caries on all tooth surfaces with gingival recession. Mandibular teeth, particularly molars and premolars, showed the greatest attack rate. The best predictors of root caries were number of teeth remaining, calculus, plaque, and the use of medications with xerostomic effects. Medications were most predictive of maxillary root caries. The results point to the need to provide interceptive dental therapeutics for high risk geriatric populations such as those using multiple medications and with a poor history of oral care.     

The long-term effect of an oscillating/rotating electric toothbrush on gingivitis An 8-month clinical study

Abstract The purpose of this study was to evaluate the safety and efficacy of the Braun Plak Control® for the removal of supragingival plaque and improving gingival health in a long-term clinical trial, and to compare it to a regular manual toothbrush. Assessed were plaque accumulation, amount of gingival inflammation, gingival bleeding on probing, and calculus. In total, 77 young individuals were selected on the basis of having moderate gingivitis'. They were monitored over 8 months and divided among 2 groups; a control group that used a manual toothbrush and a test group that used the Braun Plak Control. The clinical assessments were repeated after 1, 2, 5, and 8 months. At baseline, subjects were handed their assigned toothbrushes together with written oral hygiene instructions. They were instructed to brush for at least 2 min. 1 month after baseline examinations, all subjects received a professional prophylaxis and oral hygiene instruction from an experienced dental hygienist. Plaque removal was reinforced at the 2- and 5-month examination. In conclusion, results indicate that the Braun Plak Control is a safe and efficient home care device. At the end of this trial, this electric toothbrush proved to be more effective than a regular manual tooth brush.     

Enhancing the effect of oral hygiene with the use of a foam brush with chlorhexidine

The maintenance of oral hygiene for hospitalized patients, particularly medically compromised and immune compromised patients, may reduce the risk of oral and systemic infection. Foam brushes have been recommended for use in these populations, however, the use of a foam brush has not been shown to be an acceptable alternative to the use of a toothbrush. In this study, we demonstrate that the use of a foam brush saturated with chlorhexidine was equally effective in measures of plaque levels and gingivitis as was the use of a toothbrush. Therefore if a toothbrush cannot be used in hospitalized patients, an alternative may be the use of chlorhexidine applied with a foam brush.     

A new oral hygiene strategy

This study was designed to see if toothbrush pressure could be considered a significant factor in the reduction of plaque among a group of orthodontic patients. Eleven orthodontic patients who had been identified previously as having chronic poor oral hygiene and the ability to tolerate only small toothbrush pressures (an average of 3 oz) were selected to participate in this study. At the beginning of the study, each of the patients was supplied with a specialized toothbrush feedback mechanism that was to be used in the routine home care. The feedback mechanism permitted the patients to gradually increase their tolerance to toothbrush pressure by moving from a target pressure of 2 oz to a target pressure of 16 oz over a period of several weeks. When the target pressure was reached, a light on the end of the brush mechanism came on, thus alerting the patient that the target had been reached. Only one of the eleven patients failed to improve her plaque score. There was, on the average, a 47% reduction in plaque scores. The statistical evidence indicates that the improved plaque scores were directly related to the higher toothbrush pressures. The present study was undertaken as an extension of a previous study that indicated good orthodontic toothbrushers used four and one half times more pressure than did chronically poor toothbrushers. This study suggests that poor toothbrushers can improve their oral hygiene significantly by increasing the pressure with which they brush.     

Long-term effect of an oral healthcare programme on oral hygiene in a nursing home

This article reports on the long-term effect of an oral healthcare programme aimed at improving and maintaining the oral hygiene of elderly residents in a nursing home. The method was based on (i) motivation and oral-care training of the nursing staff, (ii) production of picture-based oral-care procedure cards, (iii) distribution of adequate oral-care equipment, (iv) practical implementation of new routines, and (v) assessment of results attained. The level of oral hygiene in the nursing home was assessed using the mucosal-plaque score (MPS) index. Overall evaluation was made before the start of the study, after 3 months, and eventually after 6 yr. Before implementation of the oral healthcare programme, 36% of the residents had an acceptable score. Six years later, the proportion was 70%. The evaluation showed that the introduction of such an oral healthcare programme significantly improved the oral hygiene of the residents on a long-term basis. However, 30% of the residents did not achieve an acceptable score because they were very ill or dying, aggressive or wanted to brush their teeth themselves.