Oral Biofilm Control in Elders in Need of Care - An Evidence-based Step-by-step Approach to Implement the Role of "Specialised Oral Care"

Background: Daily oral hygiene with sufficient biofilm control carried out life-long are the basis for stable oral health and has not yet been satisfactorily solved for people in need of care. The situation is complex due to the various groups involved in daily oral hygiene: people in need of care who, with increasing age and comorbidities, no longer fully contribute to their own oral care; nursing staff who can substitute oral care for a young patient but possibly not completely for an elderly person with an increasing number of risk factors; general practitioners as well as dentists and practice teams in  outreach care. A further complication is the “oral transition phase of aging”, defined by this working group as a risk factor, which in the sense of a continuous general medical decline also represents a deterioration in oral health with increasing age. The evidence shows for each of the groups that measures such as training or oral hygiene interventions such as delegated regular professional tooth brushing can at least stabilize oral health. To date, however, there is no evidence-based, long-term successful care model in which a sustainably acceptable level of oral hygiene could be achieved.
Methods: For the project presented here (expected to last 3 years), the existing role profiles, responsibilities, quality management, the corresponding Standard Operating Procedures (SOPs) and the establishment of mandatory interfaces with regard to the respective contribution to oral hygiene will be established for all professional groups involved in oral care redefined for the district of Westphalia-Lippe for elders in need of care. Milestones are semi-annual evaluations of the oral hygiene situation, oral health, general health, and quality of life. In the sense of a self-learning system, interventions are optimised after each interim evaluation. Qualitative occupational group-specific surveys as well as health economic interventions will accompany the project.
Expected results: The aim is comprehensive, long-term, needs-based and risk-adapted improvement in oral hygiene and biofilm control for people in need of care with long-term positive benefits for oral health, general health, and quality of life.
Outlook: As part of the project, the long-term effort and clinical benefit of the interdisciplinary oral hygiene interventions described will be documented. This should help to develop a socially acceptable model with the participation of all professional groups involved. Ideally, the project will serve as a blueprint for widespread transfer to interdisciplinary oral hygiene care for elders in need of care in Germany.