Recommendations for research
- 1 Access to dental services in England for adults in care homes
- 2 Effectiveness and costs of oral health interventions for care home residents
- 3 Measuring improvements in care home residents' oral health
- 4 Daily mouth care for residents
- 5 Reducing demands on health and social care services
- 6 Facilitators and barriers to carrying out daily mouth care and oral health assessments for adults in care homes
The guideline committee has made the following recommendations for research.
What effect does improving and maintaining access to dental services for adults in care homes have on their oral health and general health and wellbeing?
No research studies were identified that look at care homes in England to determine what interventions are effective and cost effective at improving and maintaining access to dental services. This includes the impact on residents' oral health. Providing and maintaining access to dental services may have resource implications for care homes and it is not clear how the various approaches compare in terms of costs and benefits.
How effective and cost effective are oral health interventions in care homes including suitable person-centred outcome measures?
There is a lack of good quality data on the effectiveness of oral health interventions and the costs of delivering them to residents in care homes in England. There is also no robust data on the differential effects on sub-populations in care homes. This includes: people with dementia, people in poor physical health, those with a short life expectancy and younger adults.
It is important to have good quality data to understand the differential impact of oral health interventions to ensure equitable access to oral health treatments and services.
This data is needed for evaluation purposes, to inform future guidance and commissioning decisions, and is vital for informing efficient and fair use of increasingly limited resources.
How can interventions to improve and maintain oral health and wellbeing, or to prevent dental disease, be measured using a patient-centred approach that can also be used to judge cost effectiveness?
Oral health research tends to use clinical dental indices (such as the plaque, gingival and denture plaque indices) to provide a measure of statistical relevance. This approach often fails to recognise the difference between what clinicians value in research and what residents or care staff may value more generally. In addition, clinical dental indices cannot be used as the basis of a cost–utility analysis.
A range of person-centred measures and study designs are needed that can also be used to determine cost effectiveness. These measures would capture the views of all residents living in care homes and could include:
how much they value having a clean, pain-free, healthy mouth
how poor oral health may affect their self-esteem and general quality of life
whether or not their dignity and individuality is respected and understood in relation to having a clean, pain-free, healthy mouth (especially in regard to dentures).
Does the delivery of a daily mouth care regimen in care homes maintain or improve adult residents' oral health-related quality of life?
There is a lack of evidence on the delivery of daily mouth care for adults in care homes in England. Research is needed to find out whether this helps to maintain or improve residents' oral health and any other aspect of their physical health and wellbeing, including their self-esteem and dignity or language, reasoning and judgement.
There is little research about the oral health needs of adults with poor physical health, or a short life expectancy, or adults with dementia. It is important to understand the impact of oral health interventions on these groups to ensure equitable access to oral health services.
Do preventive oral health interventions in residential and nursing care homes reduce demands on other health and social care services?
6 Facilitators and barriers to carrying out daily mouth care and oral health assessments for adults in care homes
What are the facilitators and barriers to delivering daily oral care and conducting oral health assessments in residential and nursing care homes?