title: Effect of a multi-faceted intervention on gingival health among adults with systemic sclerosis.
abstract: OBJECTIVE
  To evaluate the effect of adaptive oral hygiene devices and orofacial exercise to improve gingival health among adults with systemic sclerosis (SSc).
  
  
  METHODS
  Forty-eight patients with SSc were assigned randomly to the multifaceted oral health intervention or usual dental care control group. Participants in the intervention group received a rechargeable, powered Oral-B® oscillating-rotating-pulsating toothbrush and a Reach® Access™ Flosser that has a toothbrush-like handle. For those with an oral aperture of less than 40 mm, orofacial exercises were taught. Participants in the control group were each given a manual toothbrush and dental floss. Participants in both groups received instructions and demonstration on the use of the devices, and were requested to perform the respective intervention twice a day for 6 months. Evaluations were at baseline, 3-, and 6-months. The main outcome was gingival index (GI), an indicator of gingival inflammation.
  
  
  RESULTS
  Both groups showed significant reduction in GI scores at 6 months (ps<0.005). Reduction in GI scores of the intervention group at 6 months was 20.8% which is considered to be clinically significant. Compared to the control group, the intervention group showed a significant and larger reduction in GI score by 8% at 6 months (p=0.0007).
  
  
  CONCLUSIONS
  Results support the use of adaptive devices and orofacial exercise to improve gingival health in adults with SSc when compared to use of manual toothbrushing and finger-held flossing. Recommending and educating patients with SSc to use adaptive devices to clean the tooth surfaces looks promising for long-term oral health improvement.
authors.affiliation: Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, USA. yuen@uab.edu.
authors.forename: Hon K
authors.initials: HK
authors.lastname: Yuen
authors.forename: Yanqiu
authors.initials: Y
authors.lastname: Weng
authors.forename: Dipankar
authors.initials: D
authors.lastname: Bandyopadhyay
authors.forename: Susan G
authors.initials: SG
authors.lastname: Reed
authors.forename: Renata S
authors.initials: RS
authors.lastname: Leite
authors.forename: Richard M
authors.initials: RM
authors.lastname: Silver
mesh_terms: D000328:Adult; D000368:Aged; D003742:Dental Devices, Home Care / Q000592:standards*; D003774:Dental Plaque Index; D004867:Equipment Design; D005081:Exercise Therapy / Q000379:methods / Q000592:standards; D005260:Female; D005881:Gingiva / Q000473:pathology; D005891:Gingivitis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009065:Mouth Rehabilitation / Q000295:instrumentation / Q000379:methods; D020247:Myofunctional Therapy; D009909:Oral Health / Q000592:standards; D010353:Patient Education as Topic; D012595:Scleroderma, Systemic / Q000150:complications* / Q000503:physiopathology; D014070:Tooth / Q000473:pathology; D014099:Toothbrushing / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome