Effect of the Bass Brushing Method on Dental Plaque and Pneumonia for Older Inpatients with Pneumonia: A Randomized Controlled Trial

Published: 8 January 2019| Version 1 | DOI: 10.17632/tf6z33txmr.1
Pi-Hua Chang, Shuo-Chun Weng, Chun-Shih Chin, Shu-Hui Yang, Li-Ying Ju, Liang-Gie Huang, Yi-Jen Chung,


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.



Nursing, Pneumonia, Dental Care, Care of Older People