Oral Hygiene Among Portuguese Older Adults

Comparison of Oral Hygiene Instruction Methods on Oral Hygiene Behaviour Among Older Adults

The goal of this clinical trial was to compare two different oral hygiene instruction methods on oral hygiene behavior in older adults. We also wanted to evaluate the self-perception of oral health changes with each instruction method. The main questions we aim to answer were:

• Which method has better results in changing oral hygiene habits?
• Which method has better results in reducing bacterial plaque?

Participants:

• Completed a questionnaire about socioeconomic aspects and oral hygiene habits;
• Were examined to assess their oral hygiene status;
• Completed a questionnaire about self-perception of oral health;
• Received oral hygiene instruction (depending on the group: Generalised Approach or Personalised Technique).

Two months later, they were assessed again on oral hygiene habits, oral hygiene status, and self-perception of oral health.

Study Overview

• Status: Completed
• Conditions: Oral Hygiene; Oral Health; Older
• Intervention / Treatment: Behavioral: General Approach Instruction; Behavioral: Personalised Technique Instruction

Detailed Description

This study aimed to evaluate the effectiveness of two different oral hygiene instruction methods on oral hygiene behavior in older adults. Secondly, we intended to assess the self-perception of oral health changes with each instruction method.

This study was a clinical trial that included a convenience sample of 60 participants attending a university dental hospital (Egas Moniz Dental Clinic, Almada, Portugal).

Data were collected in two phases: The first phase (baseline) consisted of three parts: a questionnaire focusing on the participant's socioeconomic data and oral hygiene behaviors, clinical records obtained through an intraoral examination, using the Oral Hygiene Index-Simplified (OHI-S), and oral hygiene instruction.

For the oral hygiene instruction, the sample was divided into two groups of 30 participants (n=30) each group, exposed to different methods of professional education. The first one, identified as "General Approach" (GA), focuses more broadly on the different topics of oral diseases and oral hygiene care. The second group, identified as "Personalised Technique" (PT), was based on the specific needs of each participant.

After two months, to establish a follow-up session, the self-reported questionnaire on oral hygiene behavior and self-perceived oral health was administered again and the same clinical records on OHI-S were collected.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Portugal
  • Caparica
    • Almada, Caparica, Portugal, 2825-083
      • Egas Moniz Dental Clinic

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Being able to speak and understand Portuguese;
• Being able to understand and sign an informed consent form;
• Being literate and able to comply with the study protocol.

Exclusion Criteria:

• Being edentulous;
• Being institutionalized;
• Having disabilities such as blindness, deafness, or dementia.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: General Approach (GA); This approach consisted of a 15-minute session in which the dentist attempted to impart knowledge about oral hygiene in general, highlighting some of the most common situations in this age group, namely the difficulty in achieving correct brushing and flossing, demonstrating the correct technique on a typodont (model), and alerting them to the importance of oral health to general health. Periodontal disease, tooth decay and denture care were also covered in general terms. Participants were given a written explanatory guide to reinforce good oral hygiene habits and an explanation of these diseases or conditions. Appropriate oral hygiene tools were also provided to encourage the expected improvement in oral health. Finally, there was a question-and-answer session to clarify any doubts the participant might have.	Behavioral: General Approach Instruction; Oral health instruction focused more broadly on the different topics of oral diseases and oral hygiene care.
Active Comparator: Personalised Technique (PT); This approach began with a self-examination in an extra-oral mirror by the participant to allow the professional to understand participant's perception of oral health, and the use of a plaque-disclosing solution to allow the participant to be more sensitive to the areas where brushing and flossing were not effective. Conditions such as caries lesions, major gingival recessions, areas of greater inflammation, areas where plaque accumulation or even tartar was more visible and further denture care were highlighted. The typodont (model) was then used to demonstrate the correct brushing and flossing technique. The session ended with the participant receiving an explanatory guide, a personalized plan, and more appropriate tools to promote the expected improvement in oral health. A question-and-answer session was used to clarify any doubts. This method took about approximately 20 minutes.	Behavioral: Personalised Technique Instruction; Oral health instruction based on the specific needs of each participant.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Brushing frequency	Assessment of toothbrushing frequency (<2x/day or ≥ 2x/day)	2 months
Interdental devices usage	Assessment of dental floss or interdental brushes usage (yes/no)	2 months
Denture hygiene	Assessment of daily denture cleaning (yes/no)	2 months
Denture care	Assess whether participants sleep with their dentures in (yes/no)	2 months
Oral Hygiene Clinical Indicator	Assessment of Oral Hygiene Index - Simplified (OHI-S) (Greene & Vermillion, 1964). The six surfaces examined for the OHI-S are selected from four posterior and two anterior teeth. For posterior teeth, the buccal surfaces of the selected upper molars (usually 16 and 26) and the lingual surfaces of the selected lower molars (usually 36 or 46) are examined. For the incisors, the labial surfaces of the upper right central incisor (11) and the lower left central incisor (31) are evaluated. A score from 0 to 3 was then recorded for each surface, according to the classification for each index (debris or calculus). For each participant, the debris or calculus index was obtained by summing the scores and dividing by the number of surfaces scored. The Simplified Oral Hygiene Index is the sum of the Debris Index and the Calculus Index and can range from 0 to 6, with higher scores indicating poorer oral hygiene.	2 months
Treatment needs (oral clinical observation)	Assessment of participants' treatment needs (yes/no)	2 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-perception of oral health	Assess the participants' perception of oral health (poor/good)	2 months
Xerostomia	Assessment of dry mouth perception (yes/no)	2 months
Perceived treatment needs	Assessment of participants' perception of need for treatment (yes/no)	2 months

Collaborators and Investigators

• Sponsor: Egas Moniz - Cooperativa de Ensino Superior, CRL
• Investigators: Principal Investigator: Inês C Santos, MSc, Egas Moniz School of Health & Science

Publications and helpful links

General Publications

• GREENE JC, VERMILLION JR. THE SIMPLIFIED ORAL HYGIENE INDEX. J Am Dent Assoc. 1964 Jan;68:7-13. doi: 10.14219/jada.archive.1964.0034. No abstract available.

Study record dates

Study Major Dates

• Study Start (Actual): January 30, 2023
• Primary Completion (Actual): May 29, 2023
• Study Completion (Actual): May 29, 2023

Study Registration Dates

• First Submitted: May 29, 2024
• First Submitted That Met QC Criteria: June 4, 2024
• First Posted (Actual): June 5, 2024

Study Record Updates

• Last Update Posted (Actual): June 5, 2024
• Last Update Submitted That Met QC Criteria: June 4, 2024
• Last Verified: May 1, 2024

More Information

Terms related to this study

• Keywords: oral health; oral hygiene; toothbrushing; self-perception; health motivation; dental devices
• Other Study ID Numbers: PHDICS

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: All IPD that underlie will result in a publication.
• IPD Sharing Time Frame: IPD will become available immediately after publication.
• IPD Sharing Access Criteria: Data will be available upon reasonable request. The Principal Investigator will review requests.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No