at any point. Since the researchers didn’t conduct a pilot study prior to carrying out the proposed experiment, the potential deficiencies in its design could have been overlooked. Authors also found that for the first 6 months of observation, no significant difference was seen between the two groups due to the one of the limitations of the study: limited communication and cooperation between the staff and subjects. They added that the limitation was corrected as the study proceeded and allowed to carry out the POHC more effectively. The conclusion drawn from this pretest posttest true experimental study is that POHC administered to a group of nursing home patients was associated with a reduction in prevalence of fevers and fatal pneumonia. Even though the samples were selected from a homogenous nursing home population of Japanese descent in both of the discussed pretest posttest experimental studies, this is not necessarily considered a study bias; however, it could affect the study outcomes applicability to the populations of a different descent. Abe and associates9 performed a longitudinal prospective cohort study over a period of one year to see if pneumonia could be predicted using bacteria in saliva and patients’ oral hygiene status. This correlation was used to set a standard for visualization of oral hygiene. The purpose of the study did not state that the subjects were nursing home patients. The researchers failed to state any specific inclusion or exclusions, but identified that informed consent was given by each participant. Over a period of one year, 145 Japanese residents over the age of 65 in nursing homes were evaluated. A Dental Plaque Index (DPI) and Tongue Plaque Index (TPI) were used to categorize patients into a good oral hygiene group (DPI 0, DPI 1 and TPI 0) and a poor oral hygiene group (DPI 2 and TPI 1). Saliva sampling and bacterial analysis were also used for data collection to confirm a correlation. The conclusion of this investigation showed the poor oral health group had a significant increase in febrile days and new signs of pneumonia.
subjects with aspiration pneumonia. Due to the presence of P. gingivalis in the dentate subject model, periodontal disease was considered a potential risk factor for aspiration pneumonia. The authors also mentioned xerostomia as a possible risk factor for aspiration pneumonia, as it contributes to the concentration of the number of bacteria per milliliter of saliva. This study concluded that oral health care programs are crucial for a community-living and institutionalized older people, as they may assist in the reduction of aspiration pneumonia incidence. One of the limitations of this study could be the set-up of the model that included edentulous patients. This model could not test the effects of factors associated with having teeth. However, authors further stated that the addition of a dentate model is complementary, since it identified modifiable dental risk factors that the edentulous model could not account for. Some of the results of this study needed further determination, such as the interpretation of the finding that functional units (a pair of teeth that can contact each other in chewing) are a significant risk factor in developing aspiration pneumonia. This study called for further investigations to test for a beneficial effect of oral health care programs in nursing homes. Frenkel19 performed a longitudinal open-ended questionnaire to gather qualitative data from nursing home staff. The study was looking for the attitudes, practices and critical comments concerning oral healthcare in dependent patients. The quality of oral health care provided to nursing home patients usually falls below the standard of care. In 1997, a random sample of 22 nursing homes was taken from the 96 registered with Avon Health Authority. Two hundred twenty seven questionnaires of the 396 that returned were completely or partially answered. Frenkel did not inform the reader if the responses were used from only the completed questionnaires. In total, 95% were returned, but only 57% replied with all or partial questions answered. The questions were designed to be open-ended regarding the caregivers’ views on