Poor oral health is concentrated in adults living with HIV, and periodontal disease is currently the most common oral health problem related to HIV. In the United States, nearly 50% of all adults over age 30 have periodontal disease. Oral health and general health are intimately linked. A greater emphasis on preventing and managing periodontal disease is an urgent public health priority. Applying an established, well-tested health behavior theory, the Information- Motivation-Behavioral Skills (IMB) Model, could be highly effective in reducing risk for periodontal disease and poor health outcomes in HIV+ adults. Interventions to enhance preventative behaviors in HIV+ adults would likely generalize to other populations with similar but fewer risk factors for periodontal disease. Managing gum disease is based on excellent plaque control and ongoing dental treatment; clinically, we have early evidence that when HIV+ adults are aware of their level of periodontal disease and are coached to master specific oral hygiene skills to reduce their risk (i.e. improved tooth brushing and flossing), they become more engaged in the process and demonstrate greater motivation to initiate and maintain self-care behaviors. Our long-term goal is to apply well-established health behavior theory (i.e., the IMB Model) to test our clinical finding in a rigorous, evidence-based manner. To reach that goal, we first need an observable measure of these skills (i.e., tooth brushing and flossing), since current measures used in dentistry are only indirect measures of oral hygiene skill mastery. Therefore, our Primary Aim in this application is to finalize and evaluate the psychometric properties of a provider-observed Oral Hygiene Skills Mastery (OHSIM) in a cohort of at-risk HIV+ adults (total N=123). Objective A is to finalize development of the OHSIM including a Coder's Manual and scoring algorithms for each of the two components (i.e., tooth brushing and flossing skill) as well as an overall composite score. Objective B is to establish methods for training coders and evaluate inter-rater agreement (and internal consistency) for each component measure of the OHSIM. Objective C is to assess concurrent validity by examining correlations between OHSIM components and the overall composite score against established dental outcome measures: the modified Quigley-Hein plaque index (QHI), periodontal probing depth (PPD), gingival recession (REC), clinical attachment level (CAL) and bleeding on probing (BOP), controlling for relevant demographics and oral health covariates. Development of a valid and reliable OHSIM will enable rigorous, evidenced-based behavioral oral health research that may help promote a greater emphasis on prevention in dentistry for at risk groups.

Public Health Relevance

HIV is known to increase the risk for gum disease and better oral hygiene can help improve outcomes. We have early findings that found that coaching specific skills such as tooth brushing and flossing can help HIV+ adults feel more engaged and thus obtain better home self-care. To see if oral health coaching really works, we need an accurate measure that a provider can use to observe and rate these skills. This will help us see if these skills improve over time. If this new measure is well-designed, it could be used to promote prevention and prove whether and how behavior change interventions work.

Agency
National Institute of Health (NIH)
Institute
National Institute of Dental & Craniofacial Research (NIDCR)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21DE023740-02
Application #
9115550
Study Section
Special Emphasis Panel (ZDE1)
Program Officer
Riddle, Melissa
Project Start
2015-08-01
Project End
2017-07-31
Budget Start
2016-08-01
Budget End
2017-07-31
Support Year
2
Fiscal Year
2016
Total Cost
Indirect Cost
Name
Case Western Reserve University
Department
Dentistry
Type
Schools of Dentistry/Oral Hygn
DUNS #
077758407
City
Cleveland
State
OH
Country
United States
Zip Code
44106
Vernon, Lance T; Da Silva, Andre Paes B; Seacat, Jason D (2017) In Defense of Flossing: Part II-Can We Agree It's Premature to Claim Flossing Is Ineffective to Help Prevent Periodontal Diseases? J Evid Based Dent Pract 17:149-158
Vernon, Lance T; Seacat, Jason D (2017) In Defense of Flossing: Can We Agree It's Premature to Claim Flossing is Ineffective to Prevent Dental Caries? J Evid Based Dent Pract 17:71-75
Madan Kumar, Parangimalai Diwakar; Mohandoss, Anusa Arunachalam; Walls, Theodore et al. (2016) Using smartphone video ""selfies"" to monitor change in toothbrushing behavior after a brief intervention: A pilot study. Indian J Dent Res 27:268-77
Thavarajah, Rooban; Kumar, Madan; Mohandoss, Anusa Arunachalam et al. (2015) Drilling Deeper into tooth brushing skills: Is proactive interference an under-recognized factor in oral hygiene behavior change? Curr Oral Health Rep 2:123-128