Evaluation of time and resources required for professional dental cleaning in nursing home residents

Cost-effectiveness-analysis of oral health remotivation and reinstruction in nursing homes in a cluster-randomized controlled trial

OBJECTIVES

We conducted a cluster-randomized-controlled trial (cRCT) in 18 German nursing homes (NH) to evaluate the cost-effectiveness of reinstruction and remotivation of nursing staff by dental assistants (DAs) over 13 months.

METHODS

In the intervention arm, dentists examined NH residents, identified oral health conditions, and prescribed individualized oral care interventions. Nursing staff delivered these interventions, with regular follow-up support from DAs (reinstruction and remotivation). In the control group, similar interventions were prescribed via a standardized form, without reinstruction and remotivation (standard of care). The primary outcome was Oral-Health-related Quality-of-Life (OHrQoL) using the Geriatric/General Oral Health Assessment Index (ADD-GOHAI). Secondary outcomes included Health-related Quality-of-Life (HrQoL) using the EQ-5D summary index and caries experience (DMFT index). Costs, including those for staff, materials, and travel, were assessed in Euro 2022. Cost-effectiveness ratios and bootstrapping simulations assessed cost-effectiveness-acceptability at different willingness-to-pay thresholds.

RESULTS

Of 358 recruited participants, 68 and 63 in the intervention and control group completed the study. No significant differences existed between groups in demographics or baseline health measures. After 13 months, changes in ADD-GOHAI and DMFT scores were minimal and non-significant, while EQ-5D scores decreased in the intervention group (p < 0.001). Total costs were higher in the intervention arm (median 121.10 Euro) versus the control (median 0 Euro, p < 0.001), mainly due to travel expenses. The intervention increased dental service use but demonstrated lower cost-effectiveness acceptability.

CONCLUSIONS

DA-led reinstruction did not improve OHrQoL, negatively impacted HrQoL, and increased costs. Notably, our study was suffering from significant attrition, impacting on statistical power.

CLINICAL SIGNIFICANCE

Reinstruction and remotivation by dental assistants did not improve OHrQoL, but generated significant costs, mainly due to an uptake of dental services.

TRIAL REGISTRATION

ClinicalTrials.gov (Trial registration number NCT04140929).

Evaluation of the extent of plaque removal and users' experience of alternative toothbrushes: A randomized single-blind crossover study

INTRODUCTION

In residential care, tooth brushing with a manual toothbrush can be challenging because of technical difficulties, time consumption and poor patient cooperation, resulting in a sub-optimal cleaning. The study aimed at comparing the efficiency in plaque removal, brushing time and users' experience between three toothbrushes: a single-headed conventional manual toothbrush, a triple-headed manual toothbrush and a U-shaped electric toothbrush.

METHODS

This was a single-blind crossover study with three pre-post-test conditions. Participants were 26 dental students divided into fixed pairs to play the role of caregivers and care receivers. Pre/post plaque scores were determined by two independent investigators according to the Quigley-Hein Plaque Index (QHI). Questionnaires evaluated participants' experiences. Statistical tests of significances of differences and ANOVA were performed.

RESULTS

Results showed that plaque removal was more effective for the manual toothbrush and the triple-headed toothbrush compared to the U-shaped electric toothbrush (p < 0.001). Brushing time was the longest for the single manual toothbrush (149 s). The U-shaped electric toothbrush showed significantly better results for aspects related to comfort and salivation. The manual and triple-headed toothbrush showed better results for aspects related to cleanliness and motivation to use.

CONCLUSION

Notwithstanding its favourable comfort, tooth plaque removal is not enhanced by a U-shaped electric toothbrush. The triple-headed and single-headed toothbrushes reduced plaque more substantially than the U-shaped toothbrush. In addition, the triple-headed manual toothbrush was not only effective in plaque removal, but also had a shorter brushing time and was easy to use, being an adequate alternative for care-dependent patient groups.

[Dental care for older people: opportunities and challenges]

Die Mundgesundheit der Bevölkerung in Deutschland konnte in den letzten Jahren verbessert werden; allerdings profitierten ältere und insbesondere gebrechliche sowie pflegebedürftige Menschen nicht adäquat von dieser Entwicklung. Dabei kann eine gute Mundgesundheit relevant dazu beitragen, die Herausforderungen bei Gebrechlichkeit und Pflegebedürftigkeit besser zu bewältigen. Der eingeschränkte Zugang zur zahnmedizinischen Betreuung, die manchmal eingeschränkte Kooperativität sowie die schlechtere Mundpflege in dieser Bevölkerungsgruppe erhöhen das Risiko für Karies, Parodontalerkrankungen, Zahnverlust und Zahnlosigkeit im Vergleich zur Durchschnittsbevölkerung.

Der vorliegende Beitrag gibt eine Übersicht über die zahnmedizinische Situation älterer Menschen anhand bereits publizierter Daten aus der bevölkerungsrepräsentativen Fünften Deutschen Mundgesundheitsstudie (DMS V), die im Jahr 2014 erhoben wurden. Die mittlere Anzahl der fehlenden Zähne betrug bei den 65- bis 74-Jährigen 11,1 Zähne. Bei älteren Seniorinnen und Senioren (75–100 Jahre) mit Pflegebedarf (äSmP) war die Mundgesundheit schlechter als bei denjenigen ohne Pflegebedarf (äSoP). So hatten äSoP durchschnittlich 11,8 Zähne, äSmP dagegen nur 5,7 Zähne. Der Anteil zahnloser 65- bis 74-Jähriger hatte sich seit 1997 halbiert auf 12,4 %. Bei den äS waren 32,8 % zahnlos (äSmP: 53,7 %, äSoP: 26,7 %). Mehr als 75 % der äSmP waren abnehmbar prothetisch versorgt (äSoP: 51,7 %). Vor diesem Hintergrund werden in diesem Beitrag Schnittstellen benannt, an denen eine chancengleiche Anbindung dieser Bevölkerungsgruppen an eine zahnmedizinische Versorgungsstruktur etabliert werden könnte. Diese beinhalten akutgeriatrische Krankenhausstationen und die Entwicklung weitergehender Konzepte in der aufsuchenden Versorgung zur besseren Versorgung der Betroffenen und zur Erleichterung der Pflege.

Home care aides' attitudes to training on oral health care

This study investigated home care aides' (HCAs) oral health care experience, knowledge, and their intention to receive professional training, to explain and predict factors of their intention to receive such training. This cross-sectional study collected data through a structured questionnaire. HCAs affiliated with home care agencies in Taichung, Taiwan were recruited through purposive sampling. A total of 487 questionnaires were distributed from September to December 2015 with 280 valid responses collected (57.4%).This study predicted the factors of HCAs' intention to receive oral health care training through a decision tree analysis. The decision tree model classified the respondents with an accuracy of 77.5%. The optimal predictor variable was oral health care knowledge (χ2 = 66.662, p < 0.0001). Among the low-scoring respondents on oral health care knowledge, 76.4% were classified in the "uninterested" group, whereas 84.8% of the high scorers were classified in the "interested" group. The second best predictor variable was whether oral health care is part of the job responsibility (χ2 = 7.979, p = 0.007). Among those who answered Yes, 92.9% were in the interested group, as were 76.5% of those who answered No. It is recommended to add "disease and oral care-related content" and "safety protection, assessment, and usage of oral care tools during practical oral care process" to the oral healthcare training course content for HCAs in order to improve HCAs' oral healthcare knowledge and oral care skills. These research findings are valuable and may be taken into account in the future development of the in-service educational training of oral healthcare for HCAs.