Abstract
To evaluate the effectiveness of professionally applied fluoride varnish on the incidence of dental caries amongst older adults resident in LTCFs in Northern Ireland. The oral health status of older adults within Long-Term Care Facilities (LTCFs) is significantly worse than their community living peers. Whilst evidence suggests an important role for fluoride varnish in preventing caries in this population, very few studies have evaluated this intervention. A quality improvement project was undertaken with dentate residents (n=190) in nine LTCFs who had fluoride varnish applied by Dental Care Professionals on two separate occasions during a 12-month period (intervention group). Nine LTCFs were chosen as matched controls (control group) with comparable numbers of residents of similar medical status (n=217). For the intervention group, oral hygiene training was also provided for the care home staff. A total of 407 patients (n=271 female) were included in the analyses (mean age [SD]: 84.1 [6.6] years). After 12months, the intervention group recorded a significant reduction in mean number of carious teeth (mean [95% CI]: -0.85 [-1.12, -0.58]; P<.001). Patients in the control group had significant increases in the mean number of carious teeth (mean [95% CI]: 0.21 [0.05, 0.37]; P=.012), mean plaque score (mean [95% CI]: 1.16 [0.28, 2.04]; P=.010) and mean DMFT score (mean [95% CI]: 0.13 [0.04, 0.22]; P=.004). This study demonstrates the potential role of fluoride varnish in combination with oral hygiene training for staff in the prevention and arrest of carious lesions among older adults in LTCFs.
Highlights
The World Health Organisation (WHO) has projected a rapid worldwide increase in the number of older people, defined as those aged 65 years and over, from approximately 5.24 million in 2010 to almost 1.5 million by 2050.1These changing population demographics are accompanied by concurrent trends of increased retention of natural teeth among older adults.[2,3] In 1979, 33% of the Northern Irish adult population were edentulous, compared to an estimated 4% in the most recent UK Adult Dental Health Survey.[3]
Materials and Methods: A quality improvement project was undertaken with dentate residents (n = 190) in nine Long-Term Care Facilities (LTCFs) who had fluoride varnish applied by Dental Care Professionals on two separate occasions during a 12-month period
While these findings suggest a potential role for the application of fluoride varnish as a caries preventative strategy for older adults in LTCFs, a number of limitations regarding the conduct of the study need to be acknowledged
Summary
These changing population demographics are accompanied by concurrent trends of increased retention of natural teeth among older adults.[2,3] In 1979, 33% of the Northern Irish adult population were edentulous, compared to an estimated 4% in the most recent UK Adult Dental Health Survey.[3] Edentulism among adults aged seventy-five and over has fallen from 74% to around 40% within the same period.[3] Increases in the number of natural teeth retained and the number of sound, untreated teeth have been noted, with more pronounced improvements identified among older age groups While these developments enable a greater proportion of adults to preserve a lifetime functional dentition, significant challenges exist in maintaining this dentition against the background of chronic dental diseases.[4].
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