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.

我们提出假设，与常规护理相比，使用巴斯刷牙法的住院肺炎老年患者牙菌斑数量将减少，复发性肺炎的风险亦将降低。
研究发现：干预组受试者在干预后的第四至第六个月期间牙菌斑数量持续减少（p = .024；p = .025；p = .000），而对照组则未观察到此类现象。在整个随访期间，两组在肺炎检测上并无显著差异。胸部X光片显示的肺炎（p = .001）和牙菌斑指数（p = .021）是预测各组肺炎风险的重要指标。
数据收集：所有受试者共接受七次评估：干预开始时的住院阶段（基线），以及出院后每月一次，共六个月。在每次评估中，受试者用稀释的10cc显色溶液（9:1水与1.5%牙菌斑显色溶液（GUM RED-COTE®，Sunstar Americas, Inc.，芝加哥，美国）漱口三分钟，由资深牙医指导的护士研究员进行评估和计算牙菌斑指数。资深胸内科医生负责胸部X光片的检测结果。
数据分析：采用描述性统计（均值、标准差、频率分布和百分比）来描述受试者特征、牙菌斑指数以及通过胸部X光片检测到的肺炎。使用卡方检验和独立样本t检验来检验各组基线属性之间的差异。基线时具有统计学意义的变量（p < .05）被纳入多元分析中的协变量。使用广义估计方程（GEE）和广义线性混合模型（GLMM）分析巴斯刷牙法对牙菌斑和肺炎的影响。使用Little's完全随机缺失数据（MCAR）检验来检验缺失数据的类型。分析使用IBM SPSS Statistics for Windows版本22.0（IBM Corp.，纽约，纽约，美国）进行，显著性水平设定为α = .05。
应用：巴斯刷牙法是出院后肺炎老年患者清除牙菌斑的一种有效的口腔卫生实践。牙菌斑指数可用于监测出院后虚弱老年患者的口腔健康和肺炎风险。护理提供者还可寻求为老年患者提供提醒和鼓励，以遵循标准刷牙方法和定期进行牙科检查。