uSing rolE-substitutioN In care-homes to improve ORal health (SENIOR)
Research type
Research Study
Full title
uSing rolE-substitutioN In care-homes to improve ORal health (SENIOR)
IRAS ID
297182
Contact name
Paul Brocklehurst
Contact email
Sponsor organisation
Bangor University
Clinicaltrials.gov Identifier
, 277548; , ; , ; , ; ,
Duration of Study in the UK
3 years, 5 months, 30 days
Research summary
Research Summary
Poor oral health for older adults residing in care homes is a significant public health problem. Unlike previous generations, about half of all care home residents now have some of their own natural teeth, but their oral health is much worse than their community living peers. These can give rise to significant avoidable health and social care costs. Despite this dental service provision in care homes is poor and extremely variable. Access to domiciliary services is difficult and unscheduled care for dental problems (including hospital admissions) is common. Emerging evidence suggests that Dental Care Professionals (DCPs) offer a viable alternative to using dentists to meet the future challenges in dental public health. DCPs are a broad range of professionals, which include Dental-Therapists (D-Ts)and Dental Nurses (DNs). In a previous feasibility study, the Chief investigator PRB demonstrated that Dental therapists (D-Ts) can identify and screen for dental caries and periodontal disease and are safe as front-line health care workers. Use of DCPs within residential homes has the potential to improve the productivity of the provision of care and improve access to services.
The aim of this study is to undertake a cluster-randomised controlled trial to determine whether DCPs could reduce plaque levels (improve the oral cleanliness) of dentate older adults (65 years and over) residing in care-homes over a six-month period, when compared to ‘treatment as usual’ (commonly a reactive and ad hoc service provided by dentists). In addition, we aim to determine whether this effect is sustainable over a further six-month follow-up period.Summary of Results
What was the purpose of this study?
The SENIOR study (uUsing rolE-substitutioN In care hOmes to improve oRal health) looked at a new way to provide dental care for older adults living in care homes across the United Kingdom. Usually, residents rely on 'high-street' dentists visiting the home, but this can be very difficult to arrange. This trial tested a model of care called "role substitution." This means using other qualified dental professionals-specifically dental therapists and dental nurses-instead of 'high-street' dentists to provide check-ups, teeth cleaning and simple treatments. The goal was to see if this approach could make dental care more accessible and improve the everyday oral health of vulnerable residents.What did the study do?
The researchers ran a 6-month trial involving 48 different care homes in the UK. The care homes were randomly split into two groups. The first group of care homes continued to receive their "usual care" (their normal, day-to-day dental arrangements). The second group of care homes received the new intervention. In these homes, residents received regular, structured visits from a dedicated dental therapist and a dental nurse over a 6-month period. To measure whether the new system worked, the research team checked the amount of plaque (the sticky film of bacteria that grows on teeth) on the residents' teeth at the start of the study and again at the end of the 6 month period.What were the key findings of the study?
After 6 months, the study found that the extra visits from the dental therapists and nurses did not result in a noticeable difference or improvement in plaque levels compared to the care homes that just received their usual care. The researchers discovered that a very high number of the residents in the study suffered from severe cognitive impairment, such as advanced dementia. Because of this, it was highly challenging for residents to remember or manage their own daily toothbrushing routines in between the professional dental visits. The study concluded that simply sending dental therapists and nurses into care homes to perform treatments is not enough on its own to manage long-term oral health issues. Instead, future dental programs need to focus much more heavily on supporting, training, and helping the daily care home staff so they can provide hands-on, day-to-day mouth care for residents who can no longer manage their own oral health.Where can more information be found?
While graphics and data tables cannot be displayed directly in this form, the full, detailed results and the original design plans are publicly accessible through the following standard web links:
* Main Clinical Results and Data Tables: https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fonlinelibrary.wiley.com%252Fdoi%252F10.1111%252Fcdoe.70089%2FNBTI%2FzdDHAQ%2FAQ%2F4a7d45eb-853a-484d-be67-9ad4ecd82027%2F1%2FCicIopvdKC&data=05%7C02%7Cwales.rec5%40wales.nhs.uk%7Cbcd00237dddc4dd0cc8a08df0a56af4a%7Cbb5628b8e3284082a856433c9edc8fae%7C0%7C0%7C639241039567671781%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=uwQ8TAXTWzDwtu9dN1nzIAdJyCXguH6iwm%2BDHn0mjNc%3D&reserved=0
* Care Home Feedback and Process Evaluation: https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fonlinelibrary.wiley.com%252Fdoi%252Ffull%252F10.1111%252Fger.12749%2FNBTI%2FzdDHAQ%2FAQ%2F4a7d45eb-853a-484d-be67-9ad4ecd82027%2F2%2FkCrU-WnPpF&data=05%7C02%7Cwales.rec5%40wales.nhs.uk%7Cbcd00237dddc4dd0cc8a08df0a56af4a%7Cbb5628b8e3284082a856433c9edc8fae%7C0%7C0%7C639241039567705767%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=90gc8HYYe6zsveoaG9BcEqEjauFw3kERHT18wSIyvWA%3D&reserved=0REC name
Wales REC 5
REC reference
21/WA/0116
Date of REC Opinion
29 Apr 2021
REC opinion
Favourable Opinion