Abstract
Although it is essential for people with severe physical or mental disabilities and the elderly in need of nursing care to receive tooth brushing assistance, the risk of contamination by blood when providing such assistance has not yet been clarified. This study examined contamination of the hands of a care provider by blood during tooth brushing assistance, and discuss whether or not correct tooth brushing techniques can prevent such contamination. Subjects were 51 pairs of care providers and recipients. A dental hygienist was selected as a subject for comparison. We asked care providers to wear gloves and brush the teeth of their partner for one minute. We did not specify any method for implementing tooth brushing assistance. Following the tooth brushing session, we retrieved the gloves and conducted a luminol test. We measured the hemoglobin concentration of the saliva before and after brushing by implementing a latex agglutination test. We assessed the Plaque and Gingival Indices on another day. The dental hygienist demonstrated correct techniques for tooth brushing assistance for one minute, and underwent the same tests as conducted for the subjects. Tooth brushing was recorded on video tape.
1. There was no significant difference in the Plaque and Gingival Indices before and after tooth brushing assistance provided by care providers and the dental hygienist.
2. There were significant increases in the hemoglobin concentration of the saliva after tooth brushing assistance was provided by care providers (from 8.0±31.0 to 90.5±221.6 μg/mL) (p<0.01) and the dental hygienist (from 5.7±21.6 to 18.2±43.0 μg/mL) (p<0.01). The results show that the hemoglobin concentration of the saliva after brushing by the dental hygienist was markedly lower (p<0.01).
3. Tooth brushing methods and the Gingival Index significantly influenced the hemoglobin concentration of the saliva after tooth brushing assistance was provided. The scrubbing method had a markedly lower influence, compared to the horizontal and vertical brushing methods. The hemoglobin concentration of the saliva after brushing was significantly lower in care recipients whose Gingival Index was 0, compared to those whose index was less or more than or equal to 1.
4. No marked difference was noted in the rate of contamination of the hands by blood between brushing by care providers (15.1%) and the dental hygienist (18.9%). The rate of contamination of the fingertips and left palm was 1.9 to 11.3 and 1.9%, respectively, and contamination was not noted in other areas of the hand.
Although implementation of the scrubbing method and maintenance of gingival health reduced the risk of blood-borne infections when providing tooth brushing assistance, they did not completely eliminate contamination. It is very important to adopt standard preventive measures.
