Antibacterial treatment enhances oral health in elderly dental care

Maintaining oral health is vital for overall well-being, especially as individuals age and particularly for those residing in 24-hour-care facilities. New research proposes using antibacterial light-activated treatment to address common oral health issues, such as gingivitis and periodontitis. This approach would enhance oral health and improve the general well-being of older populations living in elderly care homes.

Finnish scientists behind the study, “Effects of regular antibacterial photodynamic therapy on oral hygiene in elderly 24-hour-care residents,” observed a decline in the number of individuals without teeth in institutional care. However, the condition of the teeth is often poor. Results from this study were recently presented at the American Association of Oral and Maxillofacial Surgeons (AAOMS) Annual Meeting in Orlando, Florida.

Dental problems—including dental caries and periodontal diseases—remain common among residents of 24-hour-care facilities, especially those aged 75 and older. This finding motivated the team of scientists to delve deeper into the topic to search for new ways to enhance the oral health of older populations.

Jaana Helenius-Hietala, DDS, PhD, Deputy Chief Dentist at the Helsinki University Hospital, said, “In Finland, the oral health of elderly individuals requires significant improvement, especially among those in long-term or residential care.”

A beneficial adjunct therapy

Helenius-Hietala is part of a study group examining the effect of a novel antibacterial oral hygiene method, called Lumoral, on the health of elderly individuals living in 24-hour facilities. The study was conducted in the Laajasalo and Roihuvuori units of Helsinki’s round-the-clock inpatient care in autumn 2022 and spring 2023. A scientific publication detailing the findings is currently in the process of being published.

Thirty-one residents participated in the study, all with a minimum of 10 teeth in their mouths. For the study, the subjects were randomized to receive either self-care guidance (control group n=y) or, in addition to guidance, antibacterial light-activated therapy implemented twice a week (treatment group n=x) as an additional treatment alongside regular oral hygiene practices, toothbrushing, and flossing.

Throughout the trial period, the oral health status of the study participants was regularly monitored by a dentist/oral hygienist using manual examination and the aMMP-8 (Active MMP-8) chairside diagnostic tool. This tool, known as the PerioSafe test, detects and quantifies matrix metalloproteinase-8 (MMP-8) levels in saliva. MMP-8 is an enzyme linked to the degradation of collagen, a crucial component of periodontal tissues. Research indicates that aMMP-8 rapid tests effectively differentiate between diseased and healthy tissues in cases of periodontal and peri-implant diseases. A negative result on the aMMP-8 test is the desired outcome in patient care, indicating healthy tissue with minimal risk of attachment loss and disease progression. This negative result also serves as a biomarker of periodontal health.^3-6

According to Helenius-Hietala, participants in both study groups received guidance on oral hygiene. The Visible Plaque Index (VPI) improved during the follow-up period in both groups. Still, in the group receiving antibacterial treatment, there was also a statistically significant improvement in the Community Periodontal Index of Treatment Needs (CPITN) index. This index is a method used to assess periodontal health by examining specific indicators, including pocket depth and bleeding upon probing, on specific teeth in various sextants of the mouth. The CPITN index categorizes periodontal conditions into four main categories: healthy periodontal tissues, gingival bleeding, calculus, and pockets. It is commonly used in dental assessments to determine the treatment needs for periodontal disease.

In the PerioSafe test, positive results were present in 53% of participants in the control group at the beginning and 30% at the end. Meanwhile, in the group receiving antibacterial treatment as an adjunct therapy, the PerioSafe test was positive in 80% at the beginning and 50% at the end. Based on the findings, researchers are confident that regular antibacterial light-activated treatment improves oral health in selected residents of 24-hour-care facilities as an adjunct to regular oral hygiene.

“Antibacterial light-activated therapy improves oral hygiene. It can also increase oral moisture, as dry mouth is common in elderly individuals with multiple medications,” explained Helenius-Hietala, reminding that toothbrushing is still necessary. “It is difficult to assess potential cost savings, but it is generally acknowledged that good oral health can reduce infection complications in older adults (e.g., aspiration pneumonia is linked to periodontitis).”

Gum disease: The root of many health problems

Why is it crucial to explore novel approaches to addressing the oral health challenges of elderly individuals? As populations age, more older adults are retaining their natural teeth, which is increasing their susceptibility to oral diseases due to the buildup of oral bacteria. Because approximately 95% of all oral diseases stem from issues with oral hygiene, it is crucial to find ways to tackle the root cause—the dental plaque—with new oral hygiene methods.

Infections in the mouth are linked to overall health. When left untreated, gum infections can progress to more severe conditions such as periodontitis or peri-implantitis, which can have significant implications for oral and systemic health. Timely detection and treatment of gum disease are essential to prevent further complications and maintain overall health.^7,8

Studies have demonstrated that regular antibacterial light-activated therapy significantly improves oral hygiene and reduces inflammation in the surrounding dental tissues. This treatment could be particularly advantageous for individuals with underlying health concerns, those more prone to dental diseases, and those who encounter significant challenges in maintaining effective oral hygiene habits due to limited functional capacity.

Regular teeth cleaning to remove plaque remains the most critical aspect of maintaining oral health. Unfortunately, this is not always realized in 24-hour-care settings. Good oral hygiene practices could prevent chronic oral infections and the potentially fatal complications they cause. Helenius-Hietala stresses that new approaches are needed to improve oral hygiene.

Limited functional capacity often leads to deficiencies in oral care practices, resulting in poor oral health outcomes. This affects individuals’ physical health and quality of life, as evidenced by lower self-reported quality of life scores among those with poorer oral hygiene.

Innovative approaches are needed to address these challenges. Antibacterial light-activated therapy has emerged as a new solution for reducing plaque levels in the mouth and combating dental plaque’s harmful bacteria. The device examined in the study is a CE-marked medical device that harnesses the power of dual-light therapy to effectively reduce dental plaque and bacterial load.⁹ The treatment is not yet available in the US market.

Developed by a cardiologist

The antibacterial method combines a light-activated antibacterial agent (Lumorinse mouth rinse) with a specific light source to target and reduce harmful oral bacteria, especially those that brushing and flossing might miss.⁹

Invention of the new oral health-enhancing method was driven by recognizing the limitations of traditional oral hygiene methods in controlling plaque and preventing diseases such as periodontitis and dental caries. Researchers aimed to develop a method to provide a more thorough antibacterial effect. The device uses a technique in which a photosensitizing agent, typically in the form of a mouthwash, is applied to the teeth. This agent adheres to dental plaque and oral bacteria. When illuminated by the device’s specific wavelength of light, the photosensitizer produces reactive oxygen species that have a local antibacterial effect without causing damage to the surrounding tissues.^9-12

The antibacterial teeth cleaning method was developed by collaborating with dental professionals, microbiologists, and photodynamic therapy experts who aimed to create a user-friendly, effective, and noninvasive treatment option for enhancing oral hygiene at home. This collaborative effort ensured that the technology was both practical for daily use and scientifically grounded to provide benefits in reducing oral bacterial loads, thereby helping prevent oral diseases.

Dr. Tommi Pätilä, a cardiovascular and transplant surgeon who is also one of the scientists behind developing the novel oral health enhancing method, said, “Good oral hygiene benefits everyone, but its importance is especially emphasized in older age groups. Within elderly care settings, the effectiveness of implementing oral hygiene practices is often inadequate, with studies revealing significant room for improvement in seniors’ oral hygiene levels. Neglecting oral hygiene heightens the risk of comorbidities, underscoring the critical nature of prioritizing hygiene.”

Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.

References

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