Effect of the Bass Brushing Method on Dental Plaque and Pneumonia for Older Inpatients with Pneumonia: A Randomized Controlled Trial

We hypothesized that compared to usual care, older adults hospitalized with pneumonia who use the Bass brushing method would have less dental plaque and recurrent pneumonia.
Findings:
Participants in the intervention group experienced a sustained reduction in dental plaque from the fourth to the sixth months (p = .024; p = .025; p = .000, respectively) that was not found in the control group. There were no group differences in detected pneumonia throughout the follow-up period. Pneumonia as detected on the chest x-rays at baseline (p = .001) and dental plaque index (p = .021) were significant predictors of the risk of pneumonia across groups.
Data Collection:
All participants were evaluated seven times: at the beginning of the intervention in the hospital (baseline), and once a month for six months after discharge. At each assessment, participants gargled with a diluted 10cc disclosing solution (9:1 water and 1.5% dental disclosing solution (GUM RED-COTE®, Sunstar Americas, Inc., Chicago, USA) for three minutes and a nurse researcher who was guided by a senior dentist assessed and calculated the dental plaque index. A senior chest medicine physician took responsibility for the outcome of the chest x-ray.
Data analysis:
Descriptive statistics (means, standard deviations, frequency distribution, and percentages) were used to characterize participant characteristics, dental plaque index, and pneumonia as detected by chest x-rays. Chi-square tests and independent t-tests were used to examine differences in baseline attributes between groups. Variables significant at baseline (p < .05) were included as covariates in multivariate analyses. Generalized estimating equations (GEE) and generalized linear mixed models (GLMM) were used to analyze the effect of the Bass brushing method on dental plaque and pneumonia. Little's missing completely at random (MCAR) test was used to examine the type of missing data. Analyses were conducted using IBM SPSS Statistics for Windows, version 22.0 (IBM Corp., New York, NY, USA), and significance levels were set at α = .05.
Applications:
The Bass brushing method is a useful oral hygiene practice for removing dental plaque in previously hospitalized older adults with pneumonia following hospital discharge. The dental plaque index can be used to monitor oral health and the risk of pneumonia in frail older adults after discharge. Care providers may also seek to provide older patients with reminders and encouragement to follow a standard tooth brushing method and undergo regular dental examinations after discharge.

本研究假设：相较于常规护理，因肺炎住院的老年患者若采用巴氏刷牙法（Bass brushing method），其牙菌斑水平与复发性肺炎的发生风险将更低。
研究结果：干预组患者的牙菌斑水平在第4至第6个月呈持续下降趋势（对应p值分别为0.024、0.025、0.000），对照组未出现该变化。整个随访期间，两组间检出肺炎的比例无显著差异。基线时胸部X线片检出的肺炎情况（p=0.001）与牙菌斑指数（p=0.021），是所有组别中肺炎发生风险的重要预测因素。
数据收集：所有受试者共接受7次评估：住院期间干预开始时（基线），以及出院后6个月内每月1次。每次评估时，受试者需用稀释后的10cc菌斑显示液（9份水与1.5%牙菌斑显示剂GUM RED-COTE®按9:1比例配制，购自美国芝加哥的Sunstar Americas, Inc.）漱口3分钟；由资深牙医指导的护理研究员对受试者进行牙菌斑指数的评估与计算。胸部X线片的结果判读由资深胸内科医师负责。
数据分析：采用描述性统计量（均值、标准差、频数分布与百分比）对受试者基线特征、牙菌斑指数以及胸部X线片检出的肺炎情况进行特征刻画。采用卡方检验与独立样本t检验，比较两组间的基线属性差异。将基线时具有统计学显著性（p<0.05）的变量作为协变量纳入多变量分析。采用广义估计方程（Generalized Estimating Equations, GEE）与广义线性混合模型（Generalized Linear Mixed Models, GLMM），分析巴氏刷牙法对牙菌斑与肺炎的影响。采用Little完全随机缺失（Missing Completely At Random, MCAR）检验，对缺失数据的类型进行评估。所有分析均使用美国纽约州IBM公司出品的IBM SPSS Statistics for Windows 22.0版完成，显著性水平设定为α=0.05。
应用场景：巴氏刷牙法是一种有效的口腔卫生操作手段，可用于清除因肺炎住院并已出院的老年患者的牙菌斑。牙菌斑指数可用于监测出院后体弱老年患者的口腔健康状况与肺炎发生风险。医护人员可考虑为老年患者提供刷牙指导与督促，帮助其坚持标准刷牙流程，并在出院后定期接受口腔检查。