People with tetraplegia tend to have more plaque and gingival inflammation due to lack of manual dexterity in performing oral hygiene. The combination of poor oral hygiene performance and dry mouth from xerostomia-causing medications (commonly used in this population) increase the likelihood of dental caries and periodontal disease. Poor oral health compounded with impaired respiratory function in this population may increase the risk of aspiration pneumonia.
The aims of this study are to gather preliminary evidence on the effectiveness of an oral home telecare program for people with tetraplegia, and to explore the impact of the oral home telecare experience on overall oral health care. The proposed application will be the first intervention study designed to investigate the effect of a home (rather than an office-based) oral hygiene service delivery model via videoconferencing to improve oral health in this population. The study will employ a pre- and post-test research design with a 6-month post-training follow-up. Fifty-five people with tetraplegia will be enrolled in the study. After a baseline oral health assessment and a dental scaling and prophylaxis, an individualized program of oral hygiene training using PC- based, high-speed two-way real-time interactive video teleconferencing between each individual with tetraplegia and an occupational therapist (a rehabilitation specialist) with the collaboration from a dental hygienist will be implemented. Oral hygiene performance will be facilitated using adaptive devices (a powered toothbrush and an interdental cleaning device with an enlarged handle) as part of the rehabilitation training to improve independence in performing oral hygiene. Training will be conducted once a week for 12 consecutive weeks. During these training sessions, immediate corrective feedback and reinforcement on using these adaptive devices correctly, safely, and independently to complete oral hygiene will be provided. Oral health re-assessments will be conducted at 6 months (i.e., 3-month post-training) and 9 months (i.e., 6-month post-training) from the baseline evaluation. Impact of the oral home telecare program will be explored using in-depth interviews immediately after the 12-week training and after the 3-month post-training oral health assessment. This research will examine both the short- and long-term (sustained) effects of an oral home telecare program on improving oral health among people with tetraplegia, with the ultimate goal of enhancing the quality of oral health care and reducing oral health disparities among this at-risk population.
The public health impact of implementing oral home telecare is to extend access of preventive dental care to people with tetraplegia who historically receive inadequate dental hygiene training at rehabilitation, as well as to provide appropriate oral hygiene service delivery to geographically dispersed populations with tetraplegia. The study offers the potential of building long-term habits for maintaining oral health among people with tetraplegia, thereby maintaining the continuity of care with conventional dental services. In addition, training from an occupational therapist on performing oral hygiene is a step towards integrating oral home telecare into a broad, interdisciplinary, comprehensive telerehabilitation delivery program to maintain general health and improve the quality of life for people with tetraplegia.
| Yuen, H K (2013) Effect of a home telecare program on oral health among adults with tetraplegia: a pilot study. Spinal Cord 51:477-81 |
