Effect of Weekly Professional Oral Care, During 12 Months, on the Composition of the Oral Flora and Related Variables in Dependent Elderly Residents

Ethics statement The study was approved by the Ethics Committee at the University of Gothenburg, Sweden (Permit Number 039/00).

Study and control groups After giving an informed and written consent to participate, either by the subjects themselves or by a relative or a guardian, 68 subjects were recruited from two nursing homes for elderly persons. The nursing homes, belonging to the same institution and having the same leadership, are situated in the same area of the city. The study group was recruited from one of the nursing homes and consisted of 21 women and 12 men. The control group, recruited from the second nursing home, consisted of 23 women and 12 men. To be included in the study, the subjects had to have at least 10 natural teeth and no removable dentures and be able to follow simple instructions, such as open and close the mouth. The subjects were included in the study in the order they gave their informed consent and fulfilled the inclusion criteria. Throughout the study period, the subjects in both groups were eligible for dental care for dependent individuals, as regulated by law in Sweden, including an oral health care assessment free of charge, basic dental care at subsidized rates, and nursing home personnel trained in oral health care.

Intervention The study group received professional oral care, once a week throughout the 12-month study period, by either of two dental hygienists. The oral care was carried out in the residents´ private rooms with the participant sitting in his/her own chair or lying in bed. The treatment included brushing of the teeth, at labial and lingual sides, with use of an electric toothbrush (Oral-B Professional Care 7000) and a 1100 ppm sodium fluoride dentifrice (Zendium Classic, Opus Health Care AB/Zendium). Inter-dental cleaning was carried out using inter-dental brushes (TePe: TePe, Malmö, Sweden) and toothpicks (TePe Birch: TePe, Malmö, Sweden). Information and training in oral hygiene procedures were given to those in the study group capable to understand instructions.

At the start of the intervention, each subject in the study group, as well as their main responsible nursing aid, received an electric toothbrush of the same kind as was used by the two dental hygienists (Oral-B Professional Care 7000), and instructions and training on how to use the brush. In the control group, the oral health care procedures followed the ordinary routines for the department.

Collection of clinical data and samples for microbial analysis Clinical examinations, measurements of labial minor gland salivary secretion rate, and microbial samplings were performed between 9 and 12 am (by author KL K) and were carried out in the residents´ private rooms. All microbial sampling was performed in duplicate, one week apart. The clinical examination was performed at the first of the two duplicate sampling occasions. Plaque registration followed by the collection of supragingival plaque for microbial analysis was performed at four sites, in that order. The sites selected were interproximally the upper right first and second molars, the lower left first and second molars, the upper right second incisor and the canine, and the lower left second incisor and the canine. If one or more of these teeth were missing, the closest available site was selected. The measurement of the labial minor gland salivary secretion rate, followed by microbial sampling from the tongue, was performed in that order and at the end of the registration and sampling sessions.