Promotion of periodontal health through professional toothbrushing and education on the use of the interdental brush in the elderly

Mun Mi Cho; Yong Hwan Lee; Jin Bom Kim; Jung Hwa Lee

doi:10.11149/jkaoh.2013.37.3.132

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Cho, Lee, Kim, and Lee: Promotion of periodontal health through professional toothbrushing and education on the use of the interdental brush in the elderly

Original Article

J Korean Acad Oral Health 2013;37(3):132-140.

Published online: 12 September 2013

DOI: https://doi.org/10.11149/jkaoh.2013.37.3.132

Promotion of periodontal health through professional toothbrushing and education on the use of the interdental brush in the elderly

Mun Mi Cho¹, Yong Hwan Lee², Jin Bom Kim³, Jung Hwa Lee¹

¹Department of Dental Hygiene, Dong-Eui University, Busan, Korea

²Department of Oral Health, Kosin University Graduate School, Busan, Korea

³Department of Preventive and Community Dentistry, School of Dentistry, Pusan National University, Busan, Korea

Corresponding Author: Jung Hwa Lee Department of Dental Hygiene, Dong-Eui University, 176 Eomgwangno, Busanjin-gu, Busan 614-714, Korea Tel: +82-51-890-4239 Fax: +82-51-890-2623 E-mail: yamako93@deu.ac.kr

Received 28 June 2013 Revised 24 August 2013 Accepted 25 September 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

This study is intended to evaluate the effects of promotion of periodontal health in the elderly, through professional toothbrushing and education on the use of the interdental brush, using the Gingival Bleeding Index and the Patient Hygiene Performance Index (PHP index).

Methods

The study was conducted on 87 participants, who had given the informed consent to participate in the study at a general hospital ‘B’ in Busan from June to August, 2011. After assessing the general health condition and the medical history of the participants, the Watanabe toothbrushing method was used for professional toothbrushing on four different visits, along with imparting of education on the use of the interdental brush for self-management. The periodontal health of the participants was assessed based on the extent of gingival bleeding, by using the Gingival Bleeding Index, and the degree of plaque accumulation, by using the Patient Hygiene Performance Index. The data thus obtained was analyzed using Statistical Analysis Systems (SAS) (ver 9.13), followed by frequency analysis, analysis of variance (ANOVA), and the mixed effect model.

Results

The average gingival bleeding index was 1.65 at the commencement of the study and 1.25, 0.88, and 0.65, after the first, second and third trial, respectively. The PHP index of dental plaque was 2.90 prior to commencement of the study, 2.79, 2.77, and 2.76 after the first, second, and third trials, respectively, thus significantly improving with every successive visit. Gingival bleeding index and PHP index significantly reduced with every visit, regardless of age, smoking habits, or systemic chronic diseases such as diabetes, hypertension, central nervous system or cardiovascular diseases.

Conclusions

Education on the use of the interdental brush and professional tooth brushing promotes periodontal health, regardless of the chronic diseases seen in the elderly. Education on self-management of oral health, along with professional care at regular intervals should be recommended to effectively maintain periodontal health in the elderly.

Keywords: Dental plaque, Education, Gingival bleeding, Interdental brush, Periodontal health, Professional toothbrushing

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Table 1.

Social background of patients

Variables	Contents	Frequency	Percentage
Variables	Contents	(N)	(%)
Age (yrs)	65-70	80	91.95
	≥70	7	8.05
Smoking	No smoking	14	16.09
	Past smoking	57	65.52
	Present smoking	16	18.39
Chronic systemic diseases	Yes	65	74.71
	No	22	25.29

Table 2.

The medical history of patients by chronic systemic diseases

Variables	Contents	Frequency (N)	Percentage (%)
Diabetes
	Yes	28	32.18
	No	59	67.82
Hypertension
	Yes	44	50.57
	No	43	49.43
Chronic systemic diseases
	Yes	28	32.18
	No	59	67.82
Classification of chronic systemic disease (multiple response)
	No	22	25.29
	Diabetes	7	8.04
	Hypertension	16	18.39
	Brain, Cardiovascular	13	14.84
	Hypertension, Diabetes	14	16.09
	Brain, Cardiovascular, Diabetes	1	1.15
	Hypertension, Brain, Cardiovascular	8	9.30
	Hypertension, Brain, Cardiovascular, Diabetes	6	6.90

Table 3.

The flow of research design and procedures

Visit	Period	Process and analysis	Content instruction
1st visit	Baseline	History taking, GB measurement, PHP measurement, Professional tooth brushing, Interdental brushing education	Plaque and disclosing solution explanation, motivation, professionals brushing performed and demonstration interdental brushing
2nd visit	1 week	GB measurement, PHP measurement, Professional tooth brushing, Interdental brushing education	Check using interdental brush, disclosing solution application, motivation, demonstration, interdental brushing
3rd visit	2 weeks	GB measurement PHP measurement, Professional tooth brushing, Interdental brushing education	Check using interdental brush disclosing solution application, motivation, demonstration, interdental brushing
4th visit	3 weeks	GB measurement, PHP measurement, Professional tooth brushing, Interdental brushing education	Check using interdental brush, disclosing solution application, motivation, emphasis of continuous oral health care

GB, Gingival Bleeding Index; PHP, Patient Hygiene Performance Index.

Table 4.

Gingival bleeding indices and patient hygiene performance indices of patients by treatment period

Variables	Contents	Mean±SD	P-value*
GB indices^† (N=87)	Baseline	1.65±0.97^a	<0.001
	1 week	1.25±0.87^b
	2 weeks	0.88±0.76^c
	3 weeks	0.65±0.65^d
PHP indices^‡ (N=80)	Baseline	2.90±0.51^a	<0.001
	1 week	2.79±0.57^b
	2 weeks	2.77±0.46^b
	3 weeks	2.76±0.44^b

*P-values were obtained from the one way ANOVA.

^† Gingival Bleeding index,

^‡ Patient Hygiene Performance index.

^a bcdThe same characters were not significant by Tukey-Kramer test at α=0.05.

Table 5.

Gingival bleeding indices of patients by treatment period and variables

Variables	Baseline	1 week	2 weeks	3 weeks	P-value*
Age (yrs)
65-70	1.62±0.97^a	1.23±0.87^b	0.88±0.76^bc	0.64±0.65^d	<0.001
≥70	2.05±1.03^a	1.46±0.94^b	0.96±0.83^c	0.73±0.70^c	<0.001
P-value^†	0.183	0.481	0.804	0.768
Smoking
No smoking	1.45±0.52^a	1.06±0.48^b	0.67±0.37^c	0.39±0.31^d	<0.001
Past smoking	1.74±0.97^a	1.27±0.82^b	0.92±0.72^c	0.67±0.57^d	<0.001
Present smoking	1.53±1.29^a	1.34±1.29^a	0.97±1.11^b	0.81±1.05^b	<0.001
P-value^†	0.390	0.624	0.557	0.398
Chronic systemic diseases
Yes	1.70±0.92^a	1.27±0.78^b	0.91±0.70^c	0.68±0.55^d	<0.001
No	1.53±1.13^a	1.20±1.12^b	0.82±0.93^c	0.57±0.90^c	<0.001
P-value^†	0.419	0.745	0.686	0.632

*P-values by treatment period obtained from linear mixed model using repeated measured ANOVA.

^† P-values by content obtained from linear mixed model using repeated measured ANOVA.

^a bcdThe same characters were not significant by Tukey-Kramer test at α=0.05.

Table 6.

Patient hygiene performance indices of patients by treatment period and variable

Variables	Baseline	1 week	2 weeks	3 weeks	P-value*
Age (yrs)
65-70	2.88±0.51^a	2.78±0.57^ab	2.76±0.44^b	2.75±0.43^b	<0.001
≥70	3.09±0.54	2.92±0.63	2.83±0.65	2.83±0.65	0.125
P-value^†	0.342	0.513	0.693	0.669
Smoking
No smoking	2.81±0.44^a	2.70±0.45^ab	2.56±0.36^b	2.59±0.29^b	0.022
Past smoking	2.94±0.48^a	2.85±0.44^b	2.82±0.43^b	2.81±0.42^b	0.008
Present smoking	2.83±0.66	2.64±0.96	2.77±0.61	2.73±0.63	0.054
P-value^†	0.608	0.369	0.240	0.290
Chronic systemic diseases
Yes	2.95±0.48^a	2.84±0.49^ab	2.78±0.44^b	2.77±0.43^b	<0.001
No	2.75±0.57	2.63±0.76	2.73±0.52	2.72±0.51	0.274
P-value^†	0.123	0.106	0.344	0.274

*P-values by treatment period obtained from linear mixed model using repeated measured ANOVA.

^† P-values by content obtained from linear mixed model using repeated measured ANOVA.

^a bThe same characters were not significant by Tukey-Kramer test at α=0.05.

Table 7.

Gingival bleeding indices of patients by chronic systemic disease

Variables	Baseline	1 week	2 weeks	3 weeks	P-value*
Diabetes
Yes	1.98±0.97^a	1.50±0.90^ab	1.09±0.87^c	0.82±0.68^d	<0.001
No	1.51±0.95^a	1.14±0.84^ab	0.79±0.69^c	0.57±0.63^d	<0.001
P-value^†	0.017	0.064	0.122	0.215
Hypertension
Yes	1.73±0.98^a	1.33±0.80^b	0.96±0.74^c	0.71±0.58^d	<0.001
No	1.57±0.98^a	1.17±0.94^b	0.81±0.78^c	0.59±0.73^d	<0.001
P-value^†	0.354	0.366	0.370	0.473
Brain, Cardiovascular disease
Yes	1.67±1.06^a	1.21±0.82^b	0.83±0.71^c	0.61±0.51^d	<0.001
No	1.65±0.95^a	1.27±0.90^b	0.91±0.78^c	0.67±0.71^d	<0.001
P-value^†	0.947	0.746	0.657	0.689
Classification of chronic systemic disease (multiple response)
No	1.53±1.13^a	1.20±1.12^a	0.82±0.93^b	0.57±0.90^b	<0.001
Diabetes	1.79±1.05^a	1.31±0.98^ab	0.89±0.82^bc	0.67±0.73^c	<0.001
Hypertension	1.48±0.71^a	1.15±0.55^ab	0.87±0.53^bc	0.61±0.43^c	<0.001
Brain, Cardiovascular disease	1.54±0.65^a	1.04±0.55^ab	0.73±0.46^bc	0.57±0.36^c	<0.001
Hypertension, Diabetes	1.95±0.81^a	1.48±0.85^b	1.11±0.81^bc	0.89±0.67^c	<0.001
Hypertension, Brain, Cardiovascular disease	1.45±1.35^a	1.09±0.96^ab	0.65±0.57^bc	0.48±0.52^c	<0.001
Hypertension, Brain, Cardiovascular disease, Diabetes	2.26±1.30^a	1.74±1.00^ab	1.28±1.16^bc	0.85±0.76^c	<0.001
P-value^†	0.314	0.539	0.731	0.905

*P-values by treatment period obtained from linear mixed model using repeated measured ANOVA.

^† P-values by content obtained from linear mixed model using repeated measured ANOVA.

^a bcdThe same characters were not significant by Tukey-Kramer test at α=0.05.

Table 8.

Patient hygiene performance indices of patients by chronic systemic disease

Variables	Baseline	1 week	2 weeks	3 weeks	P-value*
Diabetes
Yes	3.12±0.52^a	2.99±0.52^b	2.91±0.39^b	2.91±0.37^b	0.004
No	2.80±0.48^a	2.70±0.58^ab	2.70±0.47^b	2.69±0.46^b	0.004
P-value^†	0.010	0.016	0.040	0.034
Hypertension
Yes	2.98±0.49^a	2.80±0.52^b	2.79±0.47^b	2.79±0.46^b	0.000
No	2.83±0.52^a	2.77±0.63^ab	2.74±0.45^ab	2.73±0.44^b	0.016
P-value^†	0.217	0.814	0.442	0.425
Brain, Cardiovascular disease
Yes	2.93±0.55^a	2.83±0.59^b	2.82±0.45^b	2.80±0.44^b	0.001
No	2.85±0.43^a	2.70±0.54^ab	2.66±0.47^b	2.67±0.45^b	0.014
P-value^†	0.553	0.375	0.356	0.501
Classification of chronic systemic disease (multiple response)
No	2.75±0.57	2.63±0.76	2.73±0.52	2.72±0.51	0.272
Diabetes	3.15±0.52^a	3.20±0.46^a	2.88±0.48^b	2.88±0.39^b	0.007
Hypertension	2.82±0.48	2.78±0.43	2.76±0.42	2.72±0.44	0.699
Brain, Cardiovascular disease	2.78±0.40	2.76±0.33	2.67±0.32	2.67±0.34	0.418
Hypertension, Diabetes	3.19±0.49^a	2.97±0.33^b	2.97±0.32^b	2.97±0.32^b	0.022
Hypertension, Brain, Cardiovascular disease	2.95±0.39^a	2.59±0.63^b	2.54±0.68^b	2.59±0.63^b	0.001
Hypertension, Brain, Cardiovascular disease, Diabetes	2.87±0.61	2.72±0.90	2.80±0.51	2.80±0.51	0.763
P-value^†	0.192	0.164	0.532	0.569

*P-values by treatment period obtained from linear mixed model using repeated measured ANOVA.

^† P-values by content obtained from linear mixed model using repeated measured ANOVA.

^a bThe same characters were not significant by Tukey-Kramer test at α=0.05.

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