EFFECT OF TOOTH BRUSHING AND CHLORHEXIDINE (0.12%) MOUTHWASH IN HOSPITALIZED ACUTE EXACERBATION (AE) CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) SUBJECTS REFERRED FROM RURAL COMMUNITY CENTRES

Background: Gingival inflammation, a loss of connective tissue and bone is characterized by periodontal diseases. If untreated would lead to teeth loss. There is increasing evidence of the relationship between periodontitis and systemic diseases, including cardiovascular diseases, adverse pregnancy outcomes, diabetes mellitus and respiratory diseases. The fourth leading cause of death in the world is due to chronic obstructive pulmonary disease (COPD). The World Health Organization predicts it to be third by 2030.  As per various observational studies, Periodontitis has been associated with COPD. An interdisciplinary community-based COPD management programme may be required to intercede the exacerbations associated with COPD. This study aimed to assess the intervention of tooth brushing and/ or mouth wash in chronic obstructive pulmonary disease (COPD) subjects on recovery & discharge of subjects referred from various community centres at the tertiary hospital. Methods:  In total, 150 COPD subjects with periodontitis from the rural community centers for pulmonary care at the tertiary hospital were divided into 3 groups. Oral hygiene instructions (modified Bass technique using soft tooth brush and toothpaste containing 1000ppm Sodium Fluoride, NaF) on brushing were introduced along with Chlorhexidine (0.12 %) mouthwash of twice day in Group A, Group B with only mouthwash, & Group C as control with only toothbrushing. This was supervised through trained nurses. The span of hospital stay until recovery from exacerbation stage were assessed & followed-up based on those recovering within 5 days & between 5-10 days with this oral health intervention. Neither oral prophylaxis nor periodontal intervention were not possible because of their acute condition in all these subjects. Results: A shorter hospital stay (< 5days) due to faster recovery were noticed in Group A & B of 76% & 72 % respectively as compared with Group C (12% only) which was of tooth brushing alone.  This could be attributed due to the possible antiplaque effects from brushing and/ or mouth wash introduced in the Group A & B, which possibly acts in inaccessible interproximal areas in patients where there was a difficulty to practice self-care with regards to oral hygiene due to poor dexterity. Conclusion : The present findings of the implementation of primary preventive care through the trained nurses at the tertiary hospital can be a feasible model. Similar training to the health auxiliaries can be delivered on the oral hygiene practices & the use of Chlorhexidine mouthwash (0.12%) as a primary preventive program in COPD subjects & may be introduced at the rural community health centres .