title: Periodontal effects of a biobehavioral prevention program.
abstract: The present study tested preventive regimens in older subjects using dental services sporadically. 297 persons aged 60-90 (mean age 72.8; 43% ethnic minorities), were randomly assigned to either a control group or four interventions with incrementally more complex preventive strategies; behavioral training (group 2), added weekly chlorhexidine rinse (group 3), added semi-annual fluoride varnish (group 4), and added semi-annual prophylaxis (group 5). The control group received dental care as they preferred, primarily emergency care. All subjects were re-examined annually for 3 years. At baseline, 190 (64%) of the subjects were considered at risk for future periodontal disease progression. At baseline there were no group differences for any clinical parameter studied. Gingival bleeding varied between 19% and 23% over time and with no group differences. After 1 year, the greater decrease in probing depth for group 5 approached significance compared to the control group (p<0.06). Clinical attachment levels (CAL) improved in group 5 compared to the control group (p<0.01 for mesio-buccal, p<0.05 for mid-buccal tooth surfaces). The group differences did not persist at year 3. At year 3 in group 1, 9.2% and in group 5, 4.9% subjects lost > or =2.0 mm CAL. 310 teeth (6.5%) were extracted during the study period. A 21% increased risk for tooth loss was found in group 2, a 15% reduced risk in group 3, a 28% reduced risk in group 4, and a 44% reduced risk in group 5 compared to the control group (Wald-statistics robust p-value 0.12). At year 3, the tooth mortality rate in groups 3, 4 and 5 combined was reduced to 59% and significantly lower than groups 1 and 2 together (p<0.04). Self-efficacy was the best predictor of periodontal disease progression (F=7.02, p<0.01). Thus older persons benefited from a preventive oral health care program.
authors.affiliation: Department of Oral Medicine, University of Washington, Seattle 98195, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Persson
authors.forename: G R
authors.initials: GR
authors.lastname: Persson
authors.forename: L V
authors.initials: LV
authors.lastname: Powell
authors.forename: H A
authors.initials: HA
authors.lastname: Kiyak
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001521:Behavior Therapy; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003071:Cognition; D016321:Dental Care for Aged / Q000379:methods* / Q000523:psychology*; D003777:Dental Prophylaxis; D005006:Ethnicity; D005260:Female; D005460:Fluorides, Topical / Q000008:administration & dosage; D006267:Health Education, Dental; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009067:Mouthwashes / Q000627:therapeutic use; D009910:Oral Hygiene / Q000523:psychology; D010510:Periodontal Diseases / Q000517:prevention & control* / Q000523:psychology*; D010512:Periodontal Index; D012044:Regression Analysis; D012737:Sex Factors; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric
chemical_list: D000890:Anti-Infective Agents; D005460:Fluorides, Topical; D009067:Mouthwashes; C010882:chlorhexidine gluconate; D002710:Chlorhexidine