Shortened outreach periodontal therapy in nursing home residents with periodontitis: A randomized controlled trial.

BACKGROUND

We examined the clinical effectiveness of shortened outreach periodontal therapy for 3 months in nursing home residents with periodontitis versus controls (no therapy).

METHODS

Nursing home residents with periodontitis were randomly assigned to either (a) one-time, shortened outreach periodontal therapy adapted to German statutory health guidelines for periodontitis patients in need of care, which included subgingival instrumentation as part of anti-infective therapy (intervention) or (b) no treatment (control). Changes in bleeding on probing (BOP), plaque index (PI), and pocket probing depth (PPD) were assessed before therapy and at 3 months.

RESULTS

Thirty-six participants were included (mean age 85 ± 6 years). In the intervention group, BOP decreased longitudinally from baseline (45 ± 20) to follow-up (35 ± 16) (change (∆) -10 ± 26; p = 0.088; effect size of Cohen's d = -0.70 (95% confidence interval (CI) [-1.40 to 0.00]). Significant decreases were observed for PI (from 1.0 ± 0.4 to 0.7 ± 0.4, respectively; ∆-0.3 ± 0.4; p = 0.010; Cohen's d = -0.56 (95% CI [-1.24 to 0.11]) and PPD (4.5 ± 0.5 to 4.0 ± 0.5 mm; ∆-0.5 ± 0.5; p = 0.004; Cohen's d = -1.32; 95% CI [-2.05 to -0.59]). Between-group comparisons revealed significant differences in BOP (p = 0.041) and PPD (p < 0.001), but not PI (p = 0.09). In generalized linear modeling, the treatment group was the main influencing factor, with oral or vestibular plaque localization also affecting treatment outcomes over time.

CONCLUSION

In nursing home residents with high plaque levels and periodontal burden, shortened outreach periodontal therapy yielded improvements in periodontal health among nursing home residents, though limited by insufficient oral hygiene and the population's high vulnerability.

TRIAL REGISTRATION: DRKS database (no. DRKS00029392).

CLINICAL TRIAL REGISTRATION: German Clinical Trials Register (DRKS), registration number DRKS00029392.

PLAIN LANGUAGE SUMMARY: This controlled study looked at the effectiveness of a special dental treatment for elderly nursing home residents with gum disease (periodontitis). The treatment, which involved cleaning and instrumentation below the gum line, was compared to no treatment. Thirty-six participants (aged 85 years, on average) were included in the study. The results showed that after 3 months, the treatment group had a significant reduction in signs of gum inflammation (measured by bleeding on probing) and a decrease in the depth of the pockets around the teeth-both indicators of gum disease. These improvements were not seen in the control group, which did not receive the treatment. The plaque levels in the mouth decreased slightly in the treatment group but did not show a strong difference compared to the control group. Overall, the findings suggest that even for older adults in nursing homes, a simple dental procedure to clean beneath the gums can improve gum health, reduce inflammation, and lower the risk of further gum disease. However, the improvements were modest, likely due to difficulties in maintaining adequate daily oral hygiene within this vulnerable population. This underscores both the importance of providing dental and periodontal care in nursing homes and the need for enhanced support with daily oral hygiene to achieve satisfactory outcomes.