March 18, 1999
Clinical trials examine a low-cost rinse to prevent tooth loss
The last 100 volunteers are being recruited for a clinical trial to determine whether an anti-bacterial oral rinse can help high-risk older adults prevent tooth loss.
The study, called Clinical Trials to Enhance Elders’ Tooth & Oral Health, is a collaborative project between the University of Washington School of Dentistry and the University of British Columbia, which began in May 1998. It is based on a pilot study conducted in Seattle between 1991-95 that showed effectiveness in reducing cavities and periodontal disease by using a chlorhexidine rinse regularly.
A total of 900 people between 60-75 are being studied in Seattle and Vancouver for five years. Half are receiving placebo rinses and the other half are receiving a regimen of chlorhexidine rinses for home use.
Participants return for yearly oral health screenings and cleanings. After five years, the researchers will “break the code” to test if there is a difference in tooth loss rates, cavities and periodontal disease indicators between those who used the chlorhexidine rinse and those who used the placebo rinse during that period.
Chlorhexidine has been in use in Europe for 30 years and in the United States for 15 years, as a prescription drug to treat already existing periodontal disease. The only known risk is that overuse can stain teeth.
“The idea of the clinical trial is to determine if chlorhexidine is effective in cutting down bacteria that cause periodontal disease and cavities. Its ultimate goal is to save teeth,” says Dr. Asuman Kiyak, professor of dentistry and director of the UW Institute on Aging.
“We have purposely selected low-income, high-risk elders who have lost teeth in the past, have some oral problems, but cannot afford to see dentists.”
Medicare doesn?t cover dental care and many elders with limited incomes often consider supplemental dental insurance too costly. Kiyak points out that even mid-income seniors only see dentists for emergencies, and many grew up without preventive care. Chlorhexidine may be a cost-effective preventive agent for these people.
More than half of the participants in both Seattle and Vancouver are minorities, primarily Asians and African-Americans. Most of those who are Asian-born have never visited dentists for preventive check-ups and many have never gone to a dentist at all. This difference in dental service utilization reflects important cultural differences in health-care attitudes, Kiyak says.
Participants receive yearly exams and cleanings but no treatment. They use the mouth rinse provided by the study (placebo or chlorhexidine) daily for one month, then weekly for five months, then daily again. After one month, the bacterial rate can be cut to almost zero; but then it slowly comes back, hence the rotating schedule.
“We hope the study shows that you can have a low-cost, easy-to-apply system at home. If someone adheres to the program, tooth loss can be prevented,” Kiyak says.
The grant was provided to the Institute on Aging in collaboration with the School of Dentistry at the UW, funded by the National Institute of Dental and Craniofacial Research, one of the National Institutes of Health.
