Effect of an educational tooth-brushing program using priming in an elderly population with dementia residing in nursing homes

Gwi-Ryung Son Hong; Jung-Soo Woo

doi:10.11149/jkaoh.2016.40.3.149

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Hong and Woo: Effect of an educational tooth-brushing program using priming in an elderly population with dementia residing in nursing homes

Original Article

J Korean Acad Oral Health 2016;40(3):149-157.

Published online: 15 September 2016

DOI: https://doi.org/10.11149/jkaoh.2016.40.3.149

Effect of an educational tooth-brushing program using priming in an elderly population with dementia residing in nursing homes

Gwi-Ryung Son Hong^2,, Jung-Soo Woo¹

¹Department of Gerontological Welfare, Graduate School of Information in Clinical Nursing, Seoul, Korea

²College of Nursing, Hanyang University, Seoul, Korea

Corresponding Author: Gwi-Ryung Son Hong College of Nursing, Hanyang University, 222 Wangsomliro, Sungdong-gu, Seoul 04763, Korea Tel: +82-2-2220-0701 Fax: +82-2-2295-2074 E-mail: grson@hanyang.ac.kr

Received 9 May 2016 Revised 25 July 2016 Accepted 17 August 2016

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

The purpose of this study was to examine the effect of an educational program using priming on oral health, and dental plaque, and gingival bleeding indices in an elderly population with dementia (EWD) residing in nursing homes.

Methods

A pretest and posttest were conducted with a nonequivalent control group. In total, 40 participants from an EWD had the following characteristics: 1) they were aged >65 years, 2) they scored <23 points on the MMSE-DS, 3) they were able to communicate, 4) they were able to hold a toothbrush and brush his or her teeth by themselves, and 5) they had no periodontal treatment for the last 3 months. Through random sampling, participants were assigned into either the experimental (n=20) or control group (n=20). The educational program consisted of twelve 30-minute sessions (twice per week for 6 weeks). The control group was demonstrated the standard tooth-brushing method by the facility during the study period.

Results

There were no significant differences in demographics or main variables at pretest. The experimental group showed significant differences in the subjective oral health condition, as compared to the control group. The experimental group showed an increase in the level of tooth-brushing effort (t=―8.816, P<.001) and higher scores of self-evaluative dental health status (P<.001) as compared to the control group. The experimental group showed a reduced plaque index (t=11.179, P<.001) and gingival bleeding index (t=5.812, P<.001) compared to the control group. Additionally, the experimental group showed significant differences in changes of plaque index and gingival bleeding index between the pretest and posttest.

Conclusions

An interventional program on tooth brushing with priming effectively improved dental health, plaque index, and gingival bleeding index in EWDs residing in nursing homes. Direct care providers should understand the remaining abilities of EWDs and carry out priming when providing care to them.

Keywords: Dementia, Educational measurement, Memory, Nursing homes, Repetition priming, Tooth brushing

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Fig. 1.

Conditions of unimproved dental plaque index in control group.

Fig. 2.

Tooth Brushing using priming in experimental group. Make visually recognize with tooth surface colorant through direct observation via mirror. Promoted attention, interest and sensorimotor skills physical function by themselves (Enhanced cleaning the tongue, using dental floss and Increased frequency of brushing).

Table 1.

Inclusion and exclusion criteria for the study participants

Inclusion criteria	Exclusion criteria
1. Below 23 points of MMSE-DS	1. Use full denture
2. Able to communicate	2. Refuse to participate the study
3. Able to hold toothbrush and toothbrush by him or herself	3. Unable to toothbrush by himself or herself due to severe dementia
4. No periodontal treatment for last 3 months

Table 2.

Priming procedure in experimental group

Main content	Specific content and activities	Time
Reminiscence	Show familiar type of toothbrush and let them smell tooth paste	5 min
	Promote implicit memory
Word stem completion	Show the first word with blank for completion	5 min
	Then wait for 3 minutes to be completed.
	(Ex : Tooth_____? Tooth brush, Tooth _____? tooth paste)
Visual stimuli priming	Put Disclosing solution on teeth surface	5 min
	Make visually see the colored teeth via mirror
	Promote sensing of stimulation via visual priming
Demonstration with	Stimulate the sense of sight, hearing, touch through one to one demonstration	15 min
auditory sense priming	on tooth brushing with sound priming (e.g., one, two, three, four, five)
	Make imitation by viewing rolling of tooth brushing method
	Promote sensorimotor skills
	Rolling the toothbrush more than 5 times on buccal, lingual surface

Table 3.

Homogeneity test for general characteristics and main variables at baseline

Category			Experimental (n=20)	Control (n=20)	χ²/t
			n (%) or	n (%) or
			M±SD	M±SD
Gender*	Male	2 (10.0)	3 (15.0)	.229	1.000
	Female	18 (90.0)	17 (85.0)
Age*	60-69	2 (10.0)	2 (10.0)	.136	1.000
	70-79	7 (35.0)	6 (30.0)
	80-89	8 (40.0)	9 (45.0)
	≥ 90	3 (15.0)	3 (15.0)
Long-term recuperation class*	2nd Class	6 (30.0)	9 (45.0)	2.010	.445
	3rd Class	6 (30.0)	7 (35.0)
	4th Class	8 (40.0)	4 (20.0)
MMSE-DS	M±SD	18.00±4.70	17.26±4.90	.479	.634
Effort of toothbrushing		2.25±0.55	2.05±0.69	1.017	.316
Subjective oral health condition		2.55±1.05	1.85±1.04	2.118	.041
Dental plaque index		2.58±0.94	2.95±1.71	-.840	.406
Gingival bleeding index		0.37±0.19	0.44±0.25	-.943	.351

*Fisher’s exact test.

Table 4.

Effects of toothbrushing program with priming method between baseline and post-test

Measurement	Groups	Baseline	Post-test	t	P*	Change amount	t	P**
Measurement	Groups	M±SD	M±SD			M±SD	t	P**
Effort of toothbru shing	Experimental (n=20)	2.25±0.55	3.75±0.55	―8.816	<.001	1.50±0.76	8.110	<.001
	Control (n=20)	2.05±0.69	2.05±0.60	.000	1.000	0.00±0.32
Subjective oral health condition	Experimental	2.55±1.05	3.65±0.88	―4.819	<.001	1.10±1.02	3.160	.003
	Control	1.85±1.04	2.00±1.38	―.767	.453	0.15±0.88
Dental plaque index	Experimental	2.58±0.94	0.48±0.38	11.179	<.001	―2.11±0.84	―9.542	<.001
	Control	2.95±1.71	2.81±1.53	1.704	.105	―0.14±0.37
Gingival bleeding index	Experimental	0.37±0.19	0.24±0.15	5.812	<.001	―0.13±0.10	―2.888	.006
	Control	0.44±0.25	0.41±0.28	1.285	.214	―0.03±0.12

*P-value was determined by paired t-test (P<.05). **P-value was determined by independent t-test (P<.05).

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