The Effect of Domiciliary Professional Oral Care on Root Caries Progression in Care-Dependent Older Adults: A Systematic Review

With care dependency, untreated root caries lesions (RCLs) and irregular dental visits are common. RCLs, if left untreated, could lead to pain, tooth loss, difficulties eating, and impact on general health. Therefore, there is a need for prevention and effective treatment for RCLs, and especially in those with care dependency. The aim of this systematic review was to investigate the effect of domiciliary professional oral care on root caries development and progression, in comparison with self-performed or nurse-assisted oral care. A literature search was conducted in four databases in November 2022. Two authors independently screened the literature throughout the review process. Five of the identified studies were found to be relevant. Four of these were assessed as having moderate risk of bias and were included in the review, while one study had high risk of bias and was excluded from further analyses. Due to heterogenicity of the included studies (and of the interventions and outcomes), no meta-analysis or synthesis without meta-analysis (SWiM) was performed. The participation of dental personnel performing mechanical plaque removal and fluoride, or chlorhexidine application seems beneficial for care-dependent older adults with risk of RCLs development and progression. However, future studies are needed.

[1]  I. Wårdh,et al.  Oral health care beliefs among care personnel working with older people – follow‐up of oral care education provided by dental hygienists , 2022, International journal of dental hygiene.

[2]  N. Bashir Update on the prevalence of untreated caries in the US adult population, 2017-2020. , 2021, Journal of the American Dental Association.

[3]  Rakhee Patel,et al.  Protocol for A randomised feasibility trial comparing fluoride interventions to prevent dental decay in older people in care homes (FInCH trial) , 2021, BMC Oral Health.

[4]  Sie-Long Cheung,et al.  Barriers and facilitators of oral health care experienced by nursing home staff. , 2021, Geriatric nursing.

[5]  S. Watson,et al.  Evaluating the effectiveness of fluoride varnish in preventing caries amongst Long-Term Care Facility Residents. , 2021, Gerodontology.

[6]  M. Doshi,et al.  Effective mouth care for older people living in nursing homes. , 2021, Nursing older people.

[7]  E. Mayo-Wilson,et al.  PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews , 2020, BMJ.

[8]  I. Lamster,et al.  Prevention and management of periodontal diseases and dental caries in the older adults. , 2020, Periodontology 2000.

[9]  I. Wårdh,et al.  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 , 2020, Clinical interventions in aging.

[10]  M. Noack,et al.  Impact of regular professional toothbrushing on oral health, related quality of life, and nutritional and cognitive status in nursing home residents. , 2020, International journal of dental hygiene.

[11]  J. Preisser,et al.  Flossing Is Associated with Improved Oral Health in Older Adults , 2020, Journal of dental research.

[12]  N. Innes,et al.  The use of silver diamine fluoride (SDF) in dental practice , 2020, British Dental Journal.

[13]  A. Querido,et al.  Dependent person in self-care: analysis of care needs. , 2020, Scandinavian journal of caring sciences.

[14]  G. Belibasakis,et al.  Root caries: the intersection between periodontal disease and dental caries in the course of ageing , 2019, British Dental Journal.

[15]  Natalie S Blencowe,et al.  RoB 2: a revised tool for assessing risk of bias in randomised trials , 2019, BMJ.

[16]  H. Meyer-Lueckel,et al.  How to Intervene in the Root Caries Process? Systematic Review and Meta-Analyses , 2019, Caries Research.

[17]  M. Wong,et al.  Risk predictors of dental root caries: a systematic review. , 2019, Journal of dentistry.

[18]  D. Maret,et al.  Dental Caries in Geriatric Dentistry: An Update for Clinicians , 2019, International Journal of Oral and Dental Health.

[19]  H. Worthington,et al.  Fluoride toothpastes of different concentrations for preventing dental caries. , 2019, The Cochrane database of systematic reviews.

[20]  M. Noack,et al.  Efficacy of regular professional brushing by a dental nurse for 3 months in nursing home residents—A randomized, controlled clinical trial , 2019, International journal of dental hygiene.

[21]  K. Pentapati,et al.  Global and regional estimates of the prevalence of root caries – Systematic review and meta-analysis , 2018, The Saudi dental journal.

[22]  I. Wårdh,et al.  Oral health and dental care of older persons—A systematic map of systematic reviews , 2018, Gerodontology.

[23]  J. Burgess,et al.  Silver Diamine Fluoride: A Successful Anticarious Solution with Limits , 2018, Advances in dental research.

[24]  S. Fereshtehnejad,et al.  Dental care utilization in patients with different types of dementia: A longitudinal nationwide study of 58,037 individuals , 2018, Alzheimer's & Dementia.

[25]  I. Wårdh,et al.  Effect of 12‐month weekly professional oral hygiene care on the composition of the oral flora in dentate, dependent elderly residents: A prospective study , 2017, Gerodontology.

[26]  P. F. Allen,et al.  Incidence, Prevalence and Global Distribution of Root Caries. , 2017, Monographs in oral science.

[27]  M. Burrow,et al.  Management of Cavitated Root Caries Lesions: Minimum Intervention and Alternatives. , 2017, Monographs in oral science.

[28]  Hossam M. Hammady,et al.  Rayyan—a web and mobile app for systematic reviews , 2016, Systematic Reviews.

[29]  I. Wårdh,et al.  Professional Domiciliary Oral Care for Elderly in Nursing Homes—A Randomized Controlled Pilot Trial , 2016 .

[30]  M. Wong,et al.  Randomized clinical trial on arresting dental root caries through silver diammine fluoride applications in community-dwelling elders. , 2016, Journal of dentistry.

[31]  N. Johnson,et al.  Beeinflusst die Häufigkeit des Zähneputzens die Entstehung kariöser Läsionen? , 2016, Journal of dental research.

[32]  C. Hägglin,et al.  Discontinued dental attendance among elderly people in Sweden , 2016, Journal of International Society of Preventive & Community Dentistry.

[33]  S. Hines,et al.  Effectiveness of professional oral health care intervention on the oral health of residents with dementia in residential aged care facilities: a systematic review protocol , 2015, JBI database of systematic reviews and implementation reports.

[34]  F. Schwendicke,et al.  Why we need a core outcome set for trials of interventions for prevention and management of caries , 2015, Evidence-Based Dentistry.

[35]  S. J. Cobban,et al.  A scoping review of the use of fluoride varnish in elderly people living in long term care facilities , 2015 .

[36]  C. Chew‐Graham,et al.  PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews , 2014, BMC Health Services Research.

[37]  M. Hopcraft,et al.  Dental caries in Victorian nursing homes. , 2014, Australian dental journal.

[38]  A. Ritter The efficacy of fluoride on root caries progression may be dose-dependent. , 2013, The journal of evidence-based dental practice.

[39]  R. M. López,et al.  Comparison between amine fluoride and chlorhexidine with institutionalized elders: a pilot study. , 2013, Gerodontology.

[40]  R. Ellwood,et al.  A Randomized Clinical Trial of the Anti-Caries Efficacy of 5,000 Compared to 1,450 ppm Fluoridated Toothpaste on Root Caries Lesions in Elderly Disabled Nursing Home Residents , 2013, Caries Research.

[41]  E. Lo,et al.  Silver Diamine Fluoride and Education to Prevent and Arrest Root Caries among Community-Dwelling Elders , 2013, Caries Research.

[42]  L. Niessen Chlorhexidine varnish, sodium fluoride varnish, and silver diamine fluoride solution can prevent the development of new root caries in elders living in senior homes in Hong Kong. , 2012, The journal of evidence-based dental practice.

[43]  Inger Wårdh,et al.  Attitudes to and knowledge about oral health care among nursing home personnel--an area in need of improvement. , 2012, Gerodontology.

[44]  J. Bader,et al.  Root caries risk indicators: a systematic review of risk models. , 2010, Community dentistry and oral epidemiology.

[45]  Y. Luo,et al.  A Randomized Trial on Root Caries Prevention in Elders , 2010, Journal of dental research.

[46]  C. Wyatt A 5-year follow-up of older adults residing in long-term care facilities: utilisation of a comprehensive dental programme. , 2009, Gerodontology.

[47]  P. Holm-Pedersen,et al.  Development and evaluation of two root caries controlling programmes for home-based frail people older than 75 years. , 2008, Gerodontology.

[48]  A. Pearson,et al.  Oral hygiene care for residents with dementia: a literature review. , 2005, Journal of advanced nursing.

[49]  H. Kiyak,et al.  Barriers to and enablers of older adults' use of dental services. , 2005, Journal of dental education.

[50]  C. Wyatt,et al.  Caries management for institutionalized elders using fluoride and chlorhexidine mouthrinses. , 2004, Community dentistry and oral epidemiology.

[51]  A. Pearson,et al.  Oral hygiene care for adults with dementia in residential aged care facilities , 2004, JBI library of systematic reviews.

[52]  S. Gilbert,et al.  The effects of the combination of chlorhexidine/thymol- and fluoride-containing varnishes on the severity of root caries lesions in frail institutionalised elderly people , 2002 .

[53]  E. Kidd,et al.  Dental health education: An evaluation of an oral health training programme for carers of the elderly in residential homes , 2000, British Dental Journal.

[54]  E. Budtz-Jørgensen,et al.  Effects of an oral health program on selected clinical parameters and salivary bacteria in a long-term care facility. , 1998, European journal of oral sciences.

[55]  P. Holm-Pedersen,et al.  Active and inactive root surface caries lesions in a selected group of 60- to 80-year-old Danes. , 1991, Caries research.

[56]  M. MacEntee,et al.  Oral health in a long-term care institution equipped with a dental service. , 1985, Community dentistry and oral epidemiology.

[57]  R. Katz Assessing root caries in populations: the evolution of the root caries index. , 1980, Journal of public health dentistry.

[58]  C. Dolea,et al.  World Health Organization , 1949, International Organization.