Should we educate care staff to improve the oral health and oral hygiene of people with intellectual disability in residential care? Real world lessons from a randomized controlled trial

Phadraig, Caoimhin Mac Giolla; Guérin, Suzanne; Nunn, June

doi:10.1111/scd.12102

Cited by 20 publications

(13 citation statements)

References 26 publications

(70 reference statements)

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“…Of the 58 articles included in this review, 13 articles specifically involved an oral hygiene intervention for people with intellectual disabilities. Seven focused on improving the oral health knowledge and toothbrushing skills of the carers; 24‐30 one used a multi‐team approach to implement individualized oral care plans; 31 two focused on training carers to coach people with intellectual disabilities; 32,33 one focused on the use of rewards by the carers; 34 one used a moral contract approach along with re‐enforced training; 35 and one used the introduction of an new oral hygiene policy and monitoring of adherence to the policy 36 …”

Section: Resultsmentioning

confidence: 99%

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What is it about carer‐led oral hygiene interventions for people with intellectual disabilities that work and why? A realist review

Waldron

Phadraig

Nunn

2020

Comm Dent Oral Epid

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Objectives To undertake a realist review of carer‐led oral hygiene interventions for people with intellectual disabilities. This was run parallel with a Cochrane Review. Methods Realist review methods were followed. This was characterized by an iterative process of developing and refining theories of how interventions might work, expressed as context‐mechanism‐outcome configurations. The steps included identifying candidate theories with local and international expert consultation before applying an iterative search strategy. Selection criteria were applied for screening of the abstracts and 10% of the included full texts were screened by the three review members, independently, to ensure adherence to the criteria. Data were extracted in NVivo and synthesized qualitatively to confirm, refute or refine theories about what works, why, in what circumstances and for whom. Results Of the 697 potential sources, 112 studies progressed to full‐text screening, and 58 of those were included in the review. These 58 studies found evidence to support six theories about carer‐led oral hygiene interventions for people with intellectual disabilities, from a starting point of ten candidate theories. This realist review found evidence to support the contention that, in order for carer‐led oral hygiene interventions for people with ID to succeed, there is a need for adequate resources and a system‐level approach; involving carers in design and implementation; tailoring of training to suit carers’ needs and work environments; clearly stating how interventions are expected to work; specifying goals with achievable steps for carers to follow; providing carers with support and feedback on their efforts; acknowledging the physical and emotional toll caring for people with intellectual disabilities has on the well‐being of carers; and repeating training. Conclusions The theories from this realist review will direct future interventions by suggesting the mechanisms and contexts that are important to achieve the intended outcome of improved oral health for people with intellectual disabilities. These are, of course, propositions intended for testing, rather than proven. The parallel use of Cochrane and realist methods provides a unique richness to our hypothesis of what works, for whom, when and how.

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Section: Resultsmentioning

confidence: 99%

“…The remaining articles were screened by only one reviewer (CW), this is common practice in a realist review. This included screening of three articles which were co‐authored by the two other reviewers 28,29,30 …”

Section: Methodsmentioning

confidence: 99%

What is it about carer‐led oral hygiene interventions for people with intellectual disabilities that work and why? A realist review

Waldron

Phadraig

Nunn

2020

Comm Dent Oral Epid

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“…Glassman and Miller reported a decrease in plaque scores with training and coaching during oral hygiene sessions. Conversely, MacGiolla et al . reported that a pyramid‐learning design failed to significantly improve oral hygiene.…”

Section: Discussionmentioning

confidence: 99%

Could a national oral health promotion program improve the oral hygiene of persons attending special care establishments in France? Evaluation of a pilot program

Catteau

Faulks

Pereira

et al. 2018

Special Care in Dentistry

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This study aimed to investigate the effectiveness of an oral health promotion intervention implemented in special care establishments by dentists trained online. Twenty-six dentists intervening in 27 French special care establishments undertook a standardised oral health promotion intervention, including a conference presentation for care staff and hands-on toothbrushing workshops. Oral hygiene status of the residents was performed at baseline and at 6 months, and were compared using the McNemar test.Mixed logistic regression was performed to identify the factors associated with an improvement of dental plaque removal. The oral health intervention was completed by 890 residents: 445 children, 373 adults and 72 elderly adults. At baseline, dental plaque was observed for 79.8% of the 797 dentate residents. Among the 691 dentate residents included in the final analysis, dental plaque removal was improved for 34%. Improvement in dental plaque removal was recorded more often for the group of 13 to 20-year-old residents (OR = 1.97; 95% CI = 1.15-3.38). The results indicate that this programme failed to significantly improve the dental plaque removal of the residents. More research is needed to understand the limiting factors of such interventions.

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“…Several studies have shown that people with disabilities, especially those with associated motor disability, present worse oral hygiene and periodontal condition than people without a disability . These conditions are, in turn, associated with accelerated tooth loss and, ultimately, higher levels of edentulism, the lack of prosthetic replacement, and oral incapacity . Anders and Davis concluded that patients with intellectual disabilities have worse oral hygiene, higher levels of plaque, gingivitis and periodontitis, more untreated tooth decay, and a higher number of extracted teeth.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6][7] These conditions are, in turn, associated with accelerated tooth loss and, ultimately, higher levels of edentulism, the lack of prosthetic replacement, and oral incapacity. 8 Anders and Davis 4 concluded that patients with intellectual disabilities have worse oral hygiene, higher levels of plaque, gingivitis © 2019 Special Care Dentistry Association and Wiley Periodicals, Inc. and periodontitis, more untreated tooth decay, and a higher number of extracted teeth. Phadraig et al 9 found that adults over 50 are about twice as likely to be edentulous if they have intellectual disability (34% vs. 15%).…”

Section: Introductionmentioning

confidence: 99%

Characterization of oral health in a Portuguese population with mild intellectual disability

Couto

Pereira

Nunes

et al. 2019

Special Care in Dentistry

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Aims This study aims to characterize the hygiene habits, the self‐perception of the need for treatment and the oral condition of a population with a disability. Methods and Results This research is part of an observational, cross‐sectional epidemiological study on oral health and quality of life of people with mild intellectual disabilities living in (or attending) institutions of the Central Region of Portugal that were affiliated with HUMANITAS (Portuguese Federation for Mental Disability) in 2016. A sociodemographic and oral health questionnaire, applied on the form of an interview to 240 individuals aged between 18 and 64 years, was used. Statistical analyses were performed using SPSS version 22.0. It was verified that 32.9% of the individuals had less than 20 teeth. Only 15% of all individuals used removable prosthesis. About 21% didn't do oral hygiene daily. Only 28.4% of the sample visited the dentist in the last 6 months. Note that 75.2% of the sample stated their need for dental treatment and less than half (37.4%) described their oral condition as good or superior. Conclusion Dental care among adults with intellectual disability is one of the most unattended health needs. Evidence suggests that inadequate oral health habits are more prevalent in the studied population than in the Portuguese population.

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Should we educate care staff to improve the oral health and oral hygiene of people with intellectual disability in residential care? Real world lessons from a randomized controlled trial

Cited by 20 publications

References 26 publications

What is it about carer‐led oral hygiene interventions for people with intellectual disabilities that work and why? A realist review

What is it about carer‐led oral hygiene interventions for people with intellectual disabilities that work and why? A realist review

Could a national oral health promotion program improve the oral hygiene of persons attending special care establishments in France? Evaluation of a pilot program

Characterization of oral health in a Portuguese population with mild intellectual disability

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