CFDHRE Peer Reviewed Grant

Project Title:
Effects of Power Toothbrushing on Oral and Systemic Inflammation in a Nursing Home Population: A Randomized Controlled Clinical Trial

Lead Principal Applicant:
Name:Salme Lavigne, Dip DH, BA, MS(DH), (PhD candidate)
Title: Professor, Faculty of Dentistry, School of Dental Hygiene
Host Institution/Organization: University of Manitoba, Faculty of Dentistry, School of Dental Hygiene

Co-applicant:
Name: Dr. Malcolm Doupe, BPHE, MSc, PhD
Title: Assistant Professor, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba
Senior Research Scientist, Manitoba Centre for Health Policy

Award: $8,000

Abstract
Background: With aging populations and more chronic diseases, the demand for nursing home (NH) admissions has increased significantly. Institutionalized seniors have deplorable oral health and high rates of periodontal disease. Daily plaque removal is imperative for good oral health, however caregivers have an aversion and fear of providing this basic care. In addition, the suggested linkage between periodontal disease and numerous chronic inflammatory diseases prevalent in nursing homes, (stroke, respiratory, cardiovascular diseases, diabetes, arthritis) may be especially important to consider in NH's as a way of maintaining health. Aim: To document the prevalence of periodontal disease in nursing homes and assess the effects of daily power toothbrushing on oral and systemic inflammation.

Study Design: Phase 1 will describe the prevalence of periodontal disease among participants. Phase 2 is a 6 week, examiner-blinded randomized controlled clinical trial, examining changes in oral inflammation and C-reactive protein (an indicator of systemic inflammation) due to daily power toothbrushing.

Methodology: 60 subjects, will be randomized to a control (standard care) or twice daily powerbrush group. At baseline and six weeks, papillary bleeding (Loesche), gingival index (Lobene), plaque (Turesky), and C-reactive Protein (CRP) will be measured. Caregivers will answer a questionnaire regarding their oral care preferences. Consenting residents with 2 or more natural teeth, presence of oral inflammation and cognitive performance score of < 3 (indicating moderate or less impairment) will be included. Smokers, those on anti-inflammatory or antibiotic drugs, have communicable diseases, are on respirators or are comatose, will be excluded.

Statistical Analysis: Aside from descriptive statistics (Phase I data and caregiver questionnaire), mixed method regression models will be employed to measure CRP changes. Cochrane-Mantel-Haenszel tests will assess changes in non-parametric oral parameters.