Types of participants
This review will consider studies that include residents with a formal diagnosis of dementia currently residing in permanent care in RACFs.
This review will exclude participants that have not received a formal diagnosis of dementia as well as those who are not living as a permanent admission in RACFs. Studies conducted on community dwelling individuals with a formal diagnosis of dementia will be excluded.
Types of intervention(s)/phenomena of interest
This review will consider studies that evaluate the efficacy of professional oral health care (POHC) performed by a dental hygienist. These studies involve POHC performed by a dental hygienist using a toothbrush, interdental brushes, floss and hand scalers if necessary to remove plaque and food debris and in some instances hardened calculus or tartar.17,24-28 If there are studies involving the POHC being performed by dentists or a combination of dentists and dental hygienists they will be included in the analysis.
This review will exclude interventions involving staff training interventions and interventions performed by nurses/assistant nurses.
Types of outcomes
This review will consider studies that include the following outcomes: oral health in terms of plaque deposits, general oral health and decayed and/or missing teeth as measured by plaque, OHAT and Decayed Missing Filled Teeth (DMFT) scores.
Oral health as measured by:
- OHAT scores:The Oral Health Assessment Tool (OHAT) has been reported as a valid and reliable measure of assessing aspects of oral health.29 The OHAT is also a useful tool in residents with dementia.30 The scores range from 0 to 16, with a score of 0 indicating a very healthy mouth and a score of 16 indicating a very unhealthy mouth.
- Plaque scores:The Silness and Loe plaque index31 is a measurement of the state oral hygiene by recording the amount of soft debris on the teeth. The scores range from 0 to 3.
- 0= no plaque
- 1= film of plaque adhering to the gum line
- 2= moderate accumulation of soft debris
- 3= abundance of soft debris
- DMFT scores:The decayed, missing and filled teeth (DMFT) score involves a visual inspection to assess the prevalence of dental caries and dental treatment needs. The scores range from 0 to 32.
Types of studies
This review will include any experimental study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, case control studies and analytical cross sectional studies.
This review will also consider descriptive epidemiological study designs including case series, individual case reports and descriptive cross sectional studies for inclusion.
The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of MEDLINE and CINAHL will be undertaken followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies.
Studies published in English will only be considered for inclusion in this review as we are unable to translate any other languages at this stage.
Studies published during the period of 1990-201532 will be considered for inclusion in this review. This time period was chosen due to the number of publications on this topic that were being published in the literature.
The databases to be searched include: MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane Central Register of Trials and Dentistry & Oral Sciences Source (DOSS) databases.
The search for unpublished studies will include: Dissertations and thesis on ProQuest, Mednar and Google Scholar.
Initial keywords to be used:
oral health; aged care home; dementia; dentist; oral hygiene; nursing home; Alzheimer's disease; dental hygienist; dental care; residential aged care; elderly; oral health therapist; oral health care; cognitive impairment; oral health professional; institutionalized elders; dental professional
Assessment of methodological quality
Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.
Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives.
Quantitative data will, where possible be pooled in statistical meta-analysis using from Review Manager 5.2. All results will be subject to double data entry. Effect sizes expressed as odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis Heterogeneity will be assessed statistically using the standard Chi-square and also explored using subgroup analyses based on the different study designs included in this review. Additional subgroup analyses will be conducted, if sufficient data is available, to investigate the differences in residents who are able to communicate verbally versus residents who cannot communicate verbally, the differences in residents who are able to perform oral care themselves, those who require supervision and those who require full assistance. If there is sufficient data, comparisons amongst residential aged care facilities that are not for profit and for profit will be investigated as well as differences in staffing models. Where statistical pooling is not possible the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate.
Conflicts of interest
The author(s) declare that there are no known conflicts of interest.
The author(s) would like to acknowledge the contributions of Associate Professor Jane Taylor from the University of Newcastle, Dr Janet Wallace from the University of Newcastle and Professor Clive Wright from the University of Sydney and CERA, the Centre for Education Research and Ageing.
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Appendix I: Appraisal instruments
MAStARI appraisal instrument
Appendix II: Data extraction instruments
MAStARI data extraction instrument