PERIODONTAL EFFECTS OF A BIOBEHAVIORAL PREVENTION PROGRAM

The present study tested preventive regimens in older subjects using d ental services sporadically. 297 persons aged 60-90 (mean age 72.8; 43 % ethnic minorities), were randomly assigned to either a control group or four interventions with incrementally more complex preventive stra tegies; behavioral training (group 2), added weekly chlorhexidine rins e (group 3), added semi-annual fluoride varnish (group 4), and added s emi-annual prophylaxis (group 5). The control group received dental ca re as they preferred, primarily emergency can. All subjects were re-ex amined annually for 3 years. At baseline, 190 (64%) of the subjects we re considered at risk for future periodontal disease progression At ba seline there were no group differences for any clinical parameter stud ied. Gingival bleeding varied between 19% and 23% over time and with n o group differences. After 1 year the greater decrease in probing dept h for group 5 approached significance compared to the control group (p <0.06). Clinical attachment levels (CAL) improved in group 5 compared to the control group (p<0.01 for mesio-buccal, p<0.05 for mid-buccal t ooth surfaces). The group differences did not persist at year 3. At ye ar 3 in group 1, 9.2% and in group 5, 4.9% subjects lost greater than or equal to 2.0 mm CAL. 310 teeth (6.5%) were extracted during the stu dy period. A 21% increased risk for tooth loss was found in group 2, a 15% reduced risk in group 3, a 28% reduced risk in group 4, and a 44% reduced risk in group 5 compared to the control group (Wald-statistic s robust p-value 0.12). At year 3, the tooth mortality rate in groups 3, 4 and 5 combined was reduced to 59% and significantly lower than gr oups 1 and 2 together (p<0.04). Self-efficacy was the best predictor o f periodontal disease progression (F=7.02, p<0.01). Thus older persons benefited from a preventive oral health care program.