Refocusing dental care: A risk-based preventative oral health programme for dentate older people in UK care homes.

Abstract

There is strong evidence for managing the risk of dental caries, notably dose-dependent use of fluoride based on risk. Specific guidance is lacking on higher fluoride use in older people in care homes and prevention is often omitted from dental care plans. To introduce a risk-based preventative approach to existing routine dental care for older people in care homes. Three mixed residential and nursing care homes for the frail and elder (>65years) were selected to participate. All residents were risk assessed based on dependency, dentition status and self-care abilities and consequently placed on the appropriate evidence-based intervention (2800ppm high dose fluoride toothpaste and/or quarterly fluoride varnish placement). Full mouth ICDAS dental examinations were completed at baseline, 6months and 12months. At baseline, 127 risk assessments were completed in which most dentate residents (58.2%, n=74) were assessed as Risk Level 2/3 (mod/high) whilst edentulous residents were all Risk Level 1 (low) (41.7%, n=53). Only 13 (26.5%) of the 49 eligible residents completed the 12-month preventative programme. There was a significant difference in root caries (P<.0001), with 17 (51.5%) root lesions changing from active at baseline to arrested at 12months. The findings provide early indication of fluoride efficacy, especially on root caries in this vulnerable group, and highlight the challenges of delivering programme's in these complex, changing environments.