Effectiveness of On-Site Professional Oral Health Care Programs and Service Delivery within Nursing Homes:  Preventing Bacterial Mouth Infection and Pneumonia/Aspiration Pneumonia
Creators: Marusiak, Michelle J
Publisher: name: University of Alberta Library
Year: 2022

<p>Abstract<br>
Background: Seniors who are dependent on others to brush their teeth, communicate their dental needs, and provide them access to professional oral health care define dentally dependent nursing home residents in the context of this dissertation.  Oral problems in Canadian nursing home (NH) residents demonstrate poor oral health states and inadequate oral health care programmes. A novel gold standard on-site professional oral health care (POHC) programme and its components showing clinical effectiveness and cost-effectiveness outcomes to reduce dental disease does not exist and is required to support policy recommendations.<br><br>
Purpose: This Systematic Review (SR) evaluates the existing evidence on the clinical effectiveness and cost-effectiveness - inclusive of gold standard on-site POHC programme components - for the safety, efficacy, and effectiveness of reducing dental disease when compared to usual care – no on-site POHC or intervention.<br><br>
Methods:  The review is based on 13 clinical effectiveness studies.  The clinical studies include nine randomized controlled trials (RCT) based out of a total of forty NHs (3 x one, two, three, four, eight, nine, and 11 NHs), two non-RCTs based out of three NHs (one and two), and cross-sectional studies based out of three NHs (one and two).  The cost-effectiveness studies include two economic analysis studies based solely out of NHs with the comparator of usual care – no on-site POHC or intervention. <br>
Findings and conclusions:  Oral health measures were improved showing better oral health outcomes in the experimental group who received the on-site POHC intervention.  On-site POHC services once per week by Registered Dental Hygienists (RDH), twice daily oral hygiene care by nursing assistants (NA), and monthly education, improves NH resident safety by reducing preventable bacterial mouth infection, pneumonia, and fatal aspiration pneumonia (AP).  In addition, on-site POHC appears to provide motivation, remotivation, staff support, and staff evaluation in NHs which improves guidelines and standards and implements new routines using a contact person for oral care.  The policy makers need to consider policy change that provides funding according to the “level of need” to ensure all dependent NH residents receive access to essential oral health care.  Successful implementation includes funding the frequency and duration of POHC, implementing and evaluating NH guidelines and standards for daily mouth care and professional oral health care (POHC), using an POHC program to measure nursing staff oral health work in relation to defined standards, and organizing long-term presence and guidance by dental hygienists.  Some limitations across the included studies were small sample size, no control group, or not able to provide randomization.<br>
Economic analysis found the potential value of access to on-site POHC programme, compared to usual care, weighs heavily on reducing transportation and hospitalization costs and the price point set by the programme planner.  On-site POHC is a novel oral health system delivery program that provides on-site access to clinically effective, and likely cost-effective, sustainable, and high-quality care to seniors who reside in Alberta NHs.  Future studies are needed to determine the cost-effectiveness of full-time RDHs providing these essential POHC program components using a “level of need” approach for all dependent NH residents. </p>