Article Type : Research Article
Authors : Hee Ja Na
Keywords : Dentists; Dental hygienists; Infection control; Dentures; Fluoride application; Elderly; Oral care
Objective:
This study suggests that the necessity of education to self-check and manage
oral care, including oral hygiene, by identifying the oral condition of the
elderly through a survey of oral care and infection control of dental workers.
Methods:
A study was conducted on 112 dental workers working at dental clinics in
Gwangju Metropolitan City from March 1 to March 30, 2023. The study
participants were calculated with a G. power 3.1 program with an effect size of
0.3, a significance level of 0.05, and a power of 0.95.
The
survey participants understood the purpose of the study and agreed to
participate in the study, and the survey was conducted in a self-written
manner. The frequency analysis and mean and standard deviation of general matters
were conducted, and two independent samples t-test according to gender,
infection control education * cross-analysis of chlorhexidine toothpaste use,
oral management correlation for the elderly, infection control education, and
chlorhexidine toothpaste use were analysed by setting a 95% confidence
interval.
Results:
The two independent samples t-test according to gender and fluoride application
during dental care visits were 92 women, with a mean and standard deviation of
2.097 (21.129). Man 20 people, the mean and standard deviation is 3.050
(1.356). Among dental workers' visiting oral care, the t statistics according
to gender and fluoride application were -3.293, and the significance
probability was .001, indicating that there was a significant difference in
gender and fluoride application at the significance level of .05. Infection
control education * Chlorohexidine toothpaste use cross-table showed that 63
people said "very not" and 88.75% said "very not" in terms
of whether they received and practiced infection control education and 11.1%
said "very not." In other words, it was found that the majority of
dental workers received infection control education but did not practice it.
The correlation between fluoride application and gender.300, fluoride application
and tooth brushing is .465, gender and denture brushing .290, fluoride
application and denture brushing .392, tooth brushing and denture brushing
.373, gender and Chlorohexidine toothpaste use and gender are .215.390,
Fluoride application and sugar intake restrictions.392, tooth brushing and
sugar intake restrictions.612, denture brushing and sugar intake restriction
290, tooth brushing and fluoride toothpaste use.250, denture brushing and
fluoride toothpaste.250, the use of Chlorohexidine toothpaste and the use of
fluoride toothpaste were found to be .276, and the correlation between oral
management in the elderly was significant at the significance level of .01.
Conclusion:
The F notification value of infection control education and regression analysis
of chlorhexidine toothpaste use is 4.359, significance probability.
Significance level as 038.It is significantly explained in 05 (t = 2.096, p =
.038) and the total change is 38% (30% according to the correction
coefficient).
With the development of medical technology, the
average life expectancy is extended due to the improvement of living standards
and the expansion of medical services, and the number of elderly people aged 65
or older is rapidly increasing. Due to this increase in the elderly population,
interest in the health of the elderly is increasing. The health problems of the
elderly are mostly physical and functional problems, and 89.2% of the elderly
have an average of 2.6 chronic diseases [1]. Among them, oral health problems
in the elderly are one of the most common physical health problems in the
elderly [2]. Oral diseases in the elderly are becoming important. Oral health
determines the overall quality of life and is closely related to systemic
diseases, so it is important to maintain oral health care. The probability of
causing tooth loss, dental caries, and periodontal disease increases [3]. And
since oral health conditions deteriorated due to oral diseases in the elderly
are closely related to systemic health due to malnutrition as well as oral
health, oral health of the elderly can be seen as a factor that directly
affects healthy life in old age [4]. The higher the quality of life related to
oral health, the higher the quality of life, indicating that oral health is an
important factor in the quality of life. Oral health-related quality of life
simply means identifying physical, emotional, and social disorders, including
dental caries, periodontal disease-free conditions, and subjective oral
conditions [5]. In the dental clinic, a lot of saliva or blood-mixed secretions
are generated by high-speed rotary mechanisms and drinking water. Dust
generation, including various pathogenic microorganisms, is at risk of causing
a variety of pathogenic infections, ranging from colds, pneumonia,
tuberculosis, hepatitis, and acquired immunodeficiency (AIDS). Developed
countries have recognized the importance of infection control in hospitals and
are actively conducting research and activities on infection control. Shaw et
al [6]. Reported the transmission of hepatitis B between dentists and patients,
and Robinson and Challacombe reported the transmission of human
immunodeficiency virus (HIV) through dental treatment. In the 1990s, South
Korea began systematic infection control activities in earnest [7]. Since then,
the Korean Dentist Association has published a guidebook on infection
prevention practices recommended for the "dental system" in 1993 to
prepare overall clinical guidelines for infection control [8]. In 1985, the
American Dental Association issued a recommendation for preventing infection in
the dental pore environment [9]. That In 2004, the U.S. Centers for Disease
Control and Prevention published infection control guidelines in the dental
environment to minimize the spread of infection between patients and staff,
staff and patients, and included disinfection of impurities and dental
artefacts, and the environment in the dental laboratory [10]. The oral health
status of the elderly is causing deterioration of oral health due to reduced
authoring and pronunciation functions, which can improve the oral health and
quality of life of the elderly by restoring the function of lost teeth due to
dental prosthetics [11,12]. Previous studies have shown that chlorhexidine has
an effect of inhibiting tooth bacterial membrane regrowth [13,14]. Furthermore,
recent systematic studies have shown that both 0.12% chlorhexidine and 0.2%
chlorhexidine are useful for reducing the bacterial membrane and gingival index
[15]. Recently, chlorhexidine has been actively studied to prevent dental
caries by inhibiting Mutans streptococci as well as periodontal treatment.
Previous studies have shown that the comparison of chlorhexidine varnish and
fluorine vanish shows that chlorhexidine varnish is more effective in
inhibiting mutans streptococci, showing its potential for use in preventing
dental caries [16]. Therefore, this study suggests that the necessity of
education to self-check and manage oral care, including oral hygiene, by
identifying the oral condition of the elderly through a survey of oral care and
infection control of dental workers.
From March 1 to March 30, 2023, a study was conducted
on 112 dental workers working at dental clinics in Gwangju Metropolitan City.
The number of study participants was calculated as G. power 3.1 program, with
an effect size of 0.3, a significance level of 0.05, and a power of 0.95. The
survey participants understood the purpose of the study and agreed to
participate in the study, and the survey was conducted in a self-written
manner. This study was conducted with the consent of IRB (NO
1041223-201912-HR-18) at Honam University's Bio-Science Ethics Committee. The
questionnaire was measured on a Likert 5-point scale, and 5 points were given
to the Likert 5-point scale "Very Yes" and 1 point to "Very
Not" which means that the higher the score, the higher the degree of
practice.
For subjective oral health status, the tool was used by modifying and supplementing the translation of the Oral Perception Guide developed by Beck by NA [17].General matters include age, gender, work experience, and infection control education, and a total of 7 questions were fluoride application, brushing teeth, brushing dentures, using chlorhexidine toothpaste, restricting sugar intake, using fluoride toothpaste, and scaling. It was measured on a Likert 5-point scale, and Cronbach's alpha was 0.653 with a total of 7 questions.
The collected data were analysed using the SPSS
(version 21.0, SPSS Inc., Chicago, IL, USA) statistical analysis program. The
frequency analysis and mean and standard deviation of general matters were
conducted, and two independent samples t-test according to gender, infection
control education * cross-analysis of chlorhexidine toothpaste use, oral
management correlation for the elderly, infection control education, and
chlorhexidine toothpaste use were analysed by setting a 95% confidence
interval.
In Table 1, in general, age 20s 36 people 31.6%, 30s
48 people 42.1%, 40s 20 people 18.4%, 50s 3 people 2.6%, 60s 4 people 3.5% and
the mean and standard deviation are 2.026(.972). By gender, 92 women were
80.7%, 20 men were 17.5%, and the mean and standard deviation were 1.178
(.384). In terms of working experience, 27 people were 23.7% in the 1st and 2nd
years, 37 people in the 3rd and 4th years, 32 people in the 5th and 6th years,
28.1% in the 5th and 8th years, and 83.3% in the 7th and 8th years, and 14.9%
in the average and standard deviation are 1.151.
Among dental workers' visiting oral care, the two
independent sample t-test according to gender and fluoride application were 92
women, average and standard deviation 2.097 (21.129). Man 20 people, the mean
and standard deviation is 3.050 (1.356). Among dental workers' visiting oral
care, the t statistics according to gender and fluoride application were -3.293
and significance probability.001, indicating that there was a significant
difference in gender and fluoride application at the significance level of .05
(Table 2).
Table 1: Demographic matters (n=112).
item |
Sub item |
percent |
mean |
S d |
age |
20s |
36/31.6 |
2.026 |
.972 |
30s |
48/42.1 |
|||
40s |
21/18.4 |
|||
50s |
3/2.6 |
|||
60s |
4/3.5 |
|||
gender |
woman |
92/80.7 |
1.178 |
.384384) |
man |
20/17.5 |
|||
Work
experience |
1or 2years |
27/23.7 |
2.401 |
1.142 |
3or4years |
37/32.5 |
|||
5or6years |
32/28.1 |
|||
7or8years |
8/7.0 |
|||
9or10years |
8/7.0 |
|||
Infection
control education |
yes |
95/83.3 |
1.151 |
.360 |
no |
17/14.9 |
Table 2: Two independent samples by gender t-test (n=112).
item |
Sub item |
n |
mean |
S d |
t |
p |
fluoride application |
woman |
92 |
2.097 |
21.129 |
-3.293 |
.001 |
man |
20 |
3.050 |
1.356 |
Table 3: Infection control education * Cross-analysis of the use of Chlorohexidine Toothpaste (n=112).
Infection control education * Chlorohexidine
toothpaste use cross-table |
||||||||
|
Chlorohexidine toothpaste use |
total |
||||||
It's not quite. |
I don't think so. |
In general. |
That’s right. |
It is quite so |
||||
Infection
control education |
yes |
Frequency |
32 |
31 |
22 |
7 |
3 |
95 |
Chlorohexidine
toothpaste in use % |
88.9% |
88.6% |
81.5% |
100.0% |
42.9% |
84.8% |
||
no |
Frequency |
4 |
4 |
5 |
0 |
4 |
17 |
|
Chlorohexidine
toothpaste in use % |
11.1% |
11.4% |
18.5% |
0.0% |
57.1% |
15.2% |
||
total |
Frequency |
36 |
35 |
27 |
7 |
7 |
112 |
|
Chlorohexidine
toothpaste in use % |
100.0% |
100.0% |
100.0% |
100.0% |
100.0% |
100.0% |
||
X2 = 11.906 a (d f = 4, p= 0 .018) |
Table 4: Correlation of oral care for the elderly (n-112).
1 |
Fluoride-coated |
toothbrush |
Denture-cleaning |
Use chlorohexidine toothpaste |
sugar-restricted |
fluoride toothpaste |
|
gender |
1 |
|
|
|
|
|
|
Fluoride-coated |
.300** |
1 |
|
|
|
. |
|
toothbrush |
|
.465** |
1 |
|
|
|
. |
Denture-cleaning |
.290** |
.392** |
.373** |
1 |
|
. |
. |
Use chlorohexidine toothpaste |
.251** |
.390** |
|
|
1 |
|
|
sugar-restricted |
|
.392** |
.612** |
.290** |
|
1 |
|
|
|
|
|
|
|
|
|
fluoride toothpaste |
|
|
.250** |
.250** |
.276** |
|
1 |
Correlation is significant at 0.01 level (both
sides). |
Table 5: Infection control education and regression analysis of chlorhexidine toothpaste use (n=112)
Coefficient a |
||||||
Model |
Non-Standardized Coefficient |
standardized Coefficient |
t |
p |
||
B |
Standardization Error |
? |
||||
1 |
(constant) |
1.015 |
.073 |
|
13.854 |
.000 |
Use
chlorohexidine toothpaste. |
.061 |
.029 |
.196 |
2.096 |
.038 |
|
a.
Dependent variable: infection control education, R2 (adj, R2) = .38 (.30),
F=4.359 |
Infection control education * Chlorohexidine
toothpaste use cross-table showed that 63 people said "very not" and
88.75% said "very not" in terms of whether they received and
practiced infection control education and 11.1% said "very not." In
other words, it was found that the majority of dental workers received infection
control education but did not practice it (Table 3).
The correlation between fluoride application and
gender.300, fluoride application and tooth brushing is .465, gender and denture
brushing .290, fluoride application and denture brushing .392, tooth brushing
and denture brushing .373, gender and Chlorohexidine toothpaste use and gender
are .215.390, Fluoride application and sugar intake restrictions.392, tooth
brushing and sugar intake restrictions.612, denture brushing and sugar intake
restriction 290, tooth brushing and fluoride toothpaste use.250, denture
brushing and fluoride toothpaste.250, Chlorohexidine toothpaste and fluoride
toothpaste were shown as .276, and the correlation between oral management in
the elderly was significant at the significance level of .01(Table 4).
The F notification value of infection control
education and regression analysis of chlorhexidine toothpaste use is 4.359, the
probability of significance. Significance level as 038.It is significantly
explained in 05 (t = 2.096, p = .038) and the total change is 38% (30%
according to the correction factor) (Table 5).
Due to the improvement of the national standard of
living and the development of medical technology, dental caries of the elderly
in an aging society are a disease with higher discomfort in writing. In the
correlation between the need for denture according to subjective oral health
status, the need for denture was high in the elderly who said it was
uncomfortable to chew and talk [18]. Dental workers should be thoroughly aware
of infection prevention, require efforts to control and cope with infection and
take preventive measures against infectious diseases by examining the patient's
medical history and checking the overall health status [19]. In addition,
personal protective equipment such as hand washing, gloves, masks, and safety
glasses must be worn for each patient's treatment, and proper management such
as disinfection and sterilization and removal is required [20]. Elderly people
who need help in daily life are reported to have a very low priority for
high-risk groups in oral diseases [21]. The oral condition of the elderly is
frequently caused by dental caries and periodontitis due to various factors
such as tooth decay and agitation of minority remaining teeth, frequent food
entrapment, difficulty in oral hygiene management due to dull hand movements,
and oral dryness due to side effects [22]. Relatively mild lesions, such as
intraoral dental root and periodontal lesions and abrasions caused by loose
dentures in the elderly, sometimes pass through local intradermal infections
and lead to life-threatening systemic infections. In particular, periodontal
disease can cause bad breath and pain, causing discomfort to others and
malnutrition due to a decrease in the amount of food [23]. Periodontal
inflammation can increase the risk of cardiovascular disease, stroke [24,25].
Infectious endocarditis, and worsening diabetes through bacterial blood
transmission, so preventing oral disease is very important for healthy aging of
elderly patients [26]. According to previous studies, dental bacterial index,
bad breath, and tongue were continuously reduced in the experimental group
mediated in the elderly, and saliva secretion was increased in Choi's study
using toothbrushes, interdental brushes, and chlorhexidine [27]. The results
showed that patients in the intensive care unit had the ability to suppress
plaque, gum bleeding, and candy bacteria in mucosal cleaning, and the bacterial
index was significantly reduced in a short-term study conducted by experts
after eating once a week. It was small [28]. The F notification value of the
infection control education and regression analysis of chlorhexidine toothpaste
use in this study was 4.359, significance probability. Significance level as
038. 05 explains significantly (t = 2.096, p = .038) and the total change is
38% (30% according to the correction factor). According to other previous
studies, dental workers' dental care methods, characteristics of the elderly's
oral cavity, and how to use oral hygiene products were followed by oral
cleaning, denture management, and induction of regular dental visits [29]. In
addition, according to previous studies, 'the number of patients is large and
busy' showed the highest response rate as a reason for not practicing infection
prevention behaviour [30]. In this study, due to the nature of dental
treatment, dental hygienists are passive in helping dental staff with treatment
hours and the number of patients, so they are aware of infection control and
want to practice it, but the busy office environment is considered to be an
obstacle to dental hygienists' practice of infection prevention. In order to
increase the degree of practice, it is considered necessary to adjust the
workload so that the infection control procedure can be carried out. In old
age, senile diseases, digestive diseases, and respiratory diseases appear, and
oral diseases are also associated with restrictions on the intake of various
nutrients and diseases of the digestive system, which is thought to have a
secondary effect on systemic health [31]. Previous studies have shown that oral
health education for the elderly is also effective , and group education for
the elderly also improves brushing and flossing ability and reduces gingival
bleeding [32,33]. In this study's infection control education * Chlorohexidine
toothpaste use cross-table, 63 people said "very not" and 88.75% said
"very not" in terms of whether they received and practiced infection
control education, and 4 people said "very not" showed 11.1%. In
other words, it was found that the majority of dental workers received
infection control education but did not practice it < Table 3>. The need
for fluoride application in the elderly has been verified in various studies
[34]. In this study, the two independent sample t tests according to gender and
fluoride application among dental workers' visiting oral care were 92 women,
2.097 (21.129) mean and standard deviation. Man 20 people, the mean and
standard deviation is 3.050 (1.356). Among dental workers' visiting oral care,
the t statistics according to gender and fluoride application were -3.293 and
significance probability.001, indicating that there was a significant
difference in gender and fluoride application at the significance level of .05.
Whether the tap water fluoride concentration adjustment project, the expert
fluoride application self-fluorinated grapes, said that fluoride intervention
could reduce the incidence of dental caries by 0.29 (95% confidence interval
[CI], 0.16-0.42) and 0.22 (95% CI, 0.08-0.37) in adults [35]. 5,000 ppm of
fluoride toothpaste, 22,600 ppm of fluoride varnish applied, 4% chlorhexidine
varnish applied, 5% sodium fluoride varnish applied as a strategy to prevent
dental caries in the elderly. It was also proposed to apply the three-month
cycle of [36]. In this study, the correlation coefficient between fluoride
application and gender.300, fluoride application and tooth brushing is .465,
gender and denture brushing.290, fluoride application and denture brushing.373,
gender and Chlorohexidine toothpaste use and sex use.215, fluoride application
and chlornucidin.390, Fluoride application and sugar intake restrictions.392,
tooth brushing and sugar intake restrictions.612, denture brushing and sugar
intake restriction 290, tooth brushing and fluoride toothpaste use.250, denture
brushing and fluoride toothpaste.250, Chlorohexidine toothpaste and fluoride
toothpaste were shown as .276, and the correlation between oral management in
the elderly was significant at the significance level of .01 < Table 4>.
As the elderly age increases, the association between oral and systemic
diseases delays the healing of oral diseases and causes irreversible tooth
loss. And these problems are also related to socioeconomic and emotional
health. Therefore, active management and help are needed to solve the oral health
problem of the elderly. Accordingly, oral health of the elderly is considered
to be able to improve oral health of the elderly when dental caries and
periodontal diseases occur in old age, and oral disease prevention and oral
environment management, that is, oral hygiene products, and chlorhexidine
cleanser are used. The limitation of this study is that oral diseases of the
elderly appear as cumulative results, and it is difficult to change the oral
health promotion of the elderly and the basic oral health management behaviour
of the elderly. [37,38].
From March 1 to March 30, 2023, a study was conducted
on 112 dental workers working at dental clinics in Gwangju Metropolitan City.
The number of study participants was calculated as G. power 3.1 program, with
an effect size of 0.3, a significance level of 0.05, and a power of 0.95. The
survey participants understood the purpose of the study and agreed to
participate in the study, and the survey was conducted in a self-written
manner. The questionnaire was measured on a Likert 5-point scale, and 5 points
were given to the Likert 5-point scale "Very Yes" and 1 point to
"Very Not" which means that the higher the score, the higher the
degree of practice.
1. In general, age 20s 36 people 31.6%, 30s 48 people
42.1%, 40s 20 people 18.4%, 50s 3 people 2.6%, 60s 4 people 3.5%, and the mean
and standard deviation are 2.026(.972). By gender, 92 women were 80.7%, 20 men
were 17.5%, and the mean and standard deviation were 1.178 (.384). In terms of
working experience, 27 people were 23.7% in the 1st and 2nd years, 37 people in
the 3rd and 4th years, 32 people in the 5th and 6th years, 28.1% in the 5th and
8th years, and 83.3% in the 7th and 8th years, and 14.9% in the average and
standard deviation are 1.151.
2. The two independent samples t-test according to
gender and fluoride application among dental workers' visiting oral care were
92 women, 2.097 (21.129) mean and standard deviation. Man 20 people, the mean
and standard deviation is 3.050 (1.356). Among dental workers' visiting oral
care, the t statistics according to gender and fluoride application were
-3.293, and the significance probability was .001, indicating that there was a
significant difference in gender and fluoride application at the significance
level of .05.
3. Infection control education * Chlorohexidine
toothpaste use cross-table showed that 63 people said "very not" and
88.75% said "very not" in terms of whether they received and
practiced infection control education, and 4 people said "very not"
showed 11.1%. In other words, it was found that the majority of dental workers
received infection control education but did not practice it.
4. The correlation coefficient between fluoride
application and gender.300, fluoride application and tooth brushing is .465,
gender and denture brushing .290, fluoride application and denture brushing
.373, gender and Chlorohexidine toothpaste use and gender are .215, fluoride
application and Chlorohexidine toothpaste use.390, Fluoride application and
sugar intake restrictions.392, tooth brushing and sugar intake
restrictions.612, denture brushing and sugar intake restriction 290, tooth
brushing and fluoride toothpaste use.250, denture brushing and fluoride
toothpaste.250, the use of Chlorohexidine toothpaste and the use of fluoride
toothpaste were found to be .276, and the correlation between oral management
in the elderly was significant at the significance level of .01.
5. The F notification value of infection control
education and regression analysis of chlorhexidine toothpaste use is 4.359, the
probability of significance. Significance level as 038.It is significantly
explained in 05 (t = 2.096, p = .038) and the total change is 38% (30%
according to the correction coefficient).
There is no financial support and no conflict of
interest.