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.研究假设：本研究假设，与常规护理相比，住院肺炎老年患者采用巴斯刷牙法（Bass brushing method）可减少牙菌斑与复发性肺炎的发生。 研究结果：干预组患者的牙菌斑水平在第4、5、6个月呈持续降低趋势（对应p值分别为0.024、0.025、0.000），对照组未观察到该变化。随访全程中，两组间胸部X线检出的肺炎比例无显著差异。基线时胸部X线片检出的肺炎（p=0.001）与牙菌斑指数（dental plaque index）是全组受试者肺炎风险的显著预测因子。 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）1次，出院后每月1次，共6次。每次评估时，受试者使用按9:1比例混合清水与1.5%浓度GUM RED-COTE®牙菌斑显示液的稀释液（总量10cc）含漱3分钟；由资深牙医指导的护理研究员对牙菌斑指数进行评估与计算。胸部X线片结果由资深胸内科医师负责判读。 数据分析：采用描述性统计（均值、标准差、频数分布与百分比）对受试者基线特征、牙菌斑指数及胸部X线检出的肺炎情况进行特征描述。采用卡方检验与独立样本t检验比较两组间基线属性的差异。将基线时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）分析巴斯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）检验分析缺失数据类型。所有分析使用IBM SPSS Statistics 22.0 for Windows（IBM公司，美国纽约州纽约市）完成，显著性水平设定为α=0.05。 应用场景：巴斯刷牙法是一种有效的口腔卫生操作，可帮助曾因肺炎住院的老年患者出院后清除牙菌斑。牙菌斑指数可用于监测衰弱老年患者出院后的口腔健康状况与肺炎风险。医护人员可考虑为老年患者提供提醒与鼓励，使其在出院后坚持标准刷牙方法并定期接受口腔检查。