Preventive oral care strategies for care-dependent older adults

<p dir="ltr"><b>Background</b>: With care dependency, irregular dental visits are common, leading to an increased risk of poor oral status and low oral health-related quality of life (OHRQoL). Therefore, the overall aim of this thesis was to evaluate the impact of domiciliary professional dental care on oral health and OHRQoL in care- dependent older adults, and to establish recommendations for home-based preventive care.</p><p dir="ltr"><b>Methods</b>: The project was conducted between 2016 and 2024 and comprised four studies. Studies I, III and IV were randomized controlled trials. Study I followed care-dependent older adults at nursing homes for six months and investigated the effect of monthly professional dental cleaning on gingival bleeding compared with daily oral care as usual. Study II was a systematic review in which six researchers screened reports for inclusion (260 years of age and ≥1 natural tooth), intervention (professional dental cleaning at home) and outcome (root caries lesions [RCLs]), individually and in group sessions. Studies III and IV studied the additional effect of professional dental cleaning every third month on RCLs and OHRQoL among older adults with in-home care who received high- fluoride (Duraphat®) toothpaste for daily use.</p><p dir="ltr"><b>Results</b>: Study I (n=124) showed less gingival bleeding and dental plaque at six months, and the intervention group (n=69) showed fewer active RCLs (p=0.05). Study II included four studies (out of 331) that showed fewer active and new RCLs at final registrations when adding fluoride products by dental personnel. Due to heterogeneity, no meta-analysis was performed. In Studies III and IV, 82 participants (intervention=50) remained at one-year registration. Progression of RCLs were seen in both groups (22%=intervention, 28%=control) without significant difference. Correlation investigation showed an association between progression of RCLs and dental plaque amount (p=0.0014). Study IV showed moderate OHRQoL at both baseline and follow-up.</p><p dir="ltr"><b>Conclusion</b>: Additional sodium fluoride can prevent and arrest new RCLs. Professional dental cleaning may support oral hygiene at nursing homes but not among older adults with in-home care who use high-fluoride toothpaste daily. Therefore, preventive strategies should focus on availability and adherence to high-fluoride toothpaste for the dentate part of this population.</p><h3>List of scientific papers</h3><p dir="ltr">I. Girestam Croonquist C, Dalum J, Skott P, Sjögren P, Wårdh I, <b>Morén E.</b> Effects of Domiciliary Professional Oral Care for Care-Dependent Elderly in Nursing Homes - Oral Hygiene, Gingival Bleeding, Root Caries and Nursing Staff's Oral Health Knowledge and Attitudes. Clin Interv Aging. 2020;15:1305-1315.<br><a href="https://doi.org/10.2147/CIA.S236460">https://doi.org/10.2147/CIA.S236460<br></a><br></p><p dir="ltr">II. <b>Morén E,</b> Skott P, Edman K, Gavriilidou N, Wårdh I, Domeij H. The Effect of Domiciliary Professional Oral Care on Root Caries Progression in Care-Dependent Older Adults: A Systematic Review. J Clin Med. 2023;12(7):2748. <br><a href="https://doi.org/10.3390/jcm12072748">https://doi.org/10.3390/jcm12072748<br></a><br></p><p dir="ltr">III. Moren E, Skott P, Gabre P, Sjögren P, Wårdh I. Impact of Home- Based Professional Dental Cleaning on Oral Health in Care- Dependent Older Adults - A Randomized Controlled Trial - Part 1: Clinical Variables. [Manuscript]</p><p dir="ltr">IV. Moren E, Gabre P, Sjögren P, Wårdh I, Skott P. Impact of Home- Based Professional Dental Cleaning on Oral Health in Care- Dependent Older Adults - A Randomized Controlled Trial - Part 2: Self-Reported Data and Oral Health-Related Quality of Life. [Manuscript]</p>