Oral Hygiene Intervention Pilot Study

For the purposes of this pilot study, a convenience sample from six (6) to twelve (12)
nursing facilities will be selected and randomly assigned into three groups: Experimental
group 1 (educational program only, performed by a dental hygienist); Experimental group 2
(educational program plus 1% chlorhexidine varnish application monthly for the residents);
Control group (current oral hygiene practice). Several objective and subjective oral and
general health measures will be observed before and after the interventions to evaluate the
impact of the interventions on the oral and general health of the residents and also of the
direct care workers.

Assigned personnel in each nursing facility (NF) will be interviewed to identify possible
barriers to provide oral care. Each interview will take one hour, approximately.

All residents that agree to participate will be interviewed and have an oral examination and
dental plaque sample collection by the investigators. Each appointment will take 30 minutes.
The subject's health record in the nursing facilities will be abstracted for medical
information (date of birth, sex, race, source of payment for NF residency, comorbid
conditions, weight, height, medications, number of febrile days, and x-ray documented
pneumonia episodes).

After that, the educational program will be delivered in a standardized fashion for all NF in
the "educational program only group": 1) Cognitively capable residents will receive
instruction on how to perform their own oral hygiene accordingly to their own needs
(approximately 15 minutes); and 2) Direct care workers will receive instruction on how to
perform oral hygiene for dependent residents or supervise the oral hygiene routines of
independent patients (01 hour session). For both 1) and 2) above, dental hygienists will
provide a short, standardized presentation and hands-on demonstration. In addition, the
dental hygienist will provide in situ oral care (plaque and gingival bleeding index
assessment, microbiological sampling and toothbrushing with chlorhexidine mouth rinse) on a
bi-weekly basis during the study period (15 minute each appointment) .

The "educational program plus 1% chlorhexidine varnish application group" will receive the
educational program described above. In addition, residents who need supervision or are
unable to perform oral hygiene procedures will receive 1% chlorhexidine varnish application
monthly by the dental hygienist. No additional time commitment will be necessary.The direct
care workers will NOT receive any varnish.

The control group will not receive any intervention through this protocol during the formal
study period, but if the initial results are promising they will be invited after the formal
study period to receive the educational program.

After a six month period from the initial examination,all residents and direct care workers
that agree to participate will be interviewed and have an oral examination and dental plaque
sample collection by the investigators again. Each appointment will take 30 minutes.

Inclusion Criteria:

- be a resident or primary care worker in one of the following nursing homes: Linn Manor
Care Center Simpson Memorial Home, Inc., Wilton Retirement Community, All-American
Care of Muscatine, Pioneer Park of Lone Tree, Colonial Manor of the Columbus
Community, Sunrise Terrace Nursing and Rehabilitation Center Parkview Home-Wayland.

- age 21-120

Exclusion criteria:

Only those who do not sign the consent form will be excluded

Exclusion Criteria:

- not a resident or primary care worker in one of the above listed retirement homes

- age less than 21 or greater than 110