Quasi-Randomized Trial of Effects of Perioperative Oral Hygiene Instruction on Inpatients with Heart Diseases Using a Behavioral Six-Step Method

Int J Environ Res Public Health. 2019 Nov 1;16(21):4252. doi: 10.3390/ijerph16214252.


The assessor-blinded, parallel-design, quasi-randomized study (alternating allocation) aimed to determine the effects of the six-step method on postoperative numbers of oral bacteria, periodontal status, and atrial fibrillation (AF) among inpatients with heart diseases and periodontitis. Seventy inpatients who received preoperative periodontal treatment were quasi-randomly assigned to intervention and control groups at University Hospital. The intervention group received intensive oral hygiene instruction using a six-step method for 15 minutes per week and the control group received routine oral hygiene instruction. Significantly fewer oral bacteria were identified on the tongue at discharge compared with baseline in the intervention than the control group (ANCOVA) (large effect size, p = 0.02). Changes in scores for self-efficacy, plaque scores, probed pocket depth, and bleeding on probing between baseline and discharge were significantly greater in the intervention, than in the control group (p < 0.05). The period of postoperative AF (days) was significantly shorter in the intervention, than in the control group (p = 0.019). In conclusion, oral hygiene instruction using the six-step method decreased the numbers of oral bacteria on the tongue and improved self-efficacy, oral health behaviors, oral hygiene status, periodontal status, and period of postoperative AF among inpatients with periodontitis and heart diseases.

Keywords: oral hygiene instruction; perioperative period; self-efficacy; six-step method.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Dental Care / standards*
  • Dental Plaque Index
  • Female
  • Heart Diseases / surgery*
  • Humans
  • Inpatients / education*
  • Japan
  • Male
  • Middle Aged
  • Oral Hygiene / standards*
  • Patient Education as Topic / methods*
  • Periodontal Index
  • Periodontitis / therapy*
  • Perioperative Care / standards*
  • Practice Guidelines as Topic
  • Random Allocation