Root caries – effect of domiciliary professional oral care

As oral health has improved an increasing proportion of older patients are retraining their teeth increasing the proportion of teeth at risk of root caries. In the care-dependent group of older patients root caries lesions can be common so there is a need for effective prevention and treatment.

The aim of this review was to investigate the effect of domiciliary professional oral care on root caries development and progression in care-dependent older adults, in comparison with self-performed or nurse-assisted oral care.

Methods

A protocol was registered on the PROSPERO database. Searches were conducted in Medline/PubMed, The Cochrane Library and CINHAL. Peer-reviewed randomised controlled trials (RCTs), non-randomised controlled trials and systematic reviews published in Danish, English, French, German, Norwegian or Swedish were considered. Screening and selection of studies was carried out independently by all 6 reviewers working in pairs with disagreements being resolved by discussion. Study quality was assessed using with the Cochrane risk-of-bias (RoB2) tool for RCTs and ROBINS-I tool for non-randomised studies. Data abstraction was undertaken independently by two reviewers. Meta-analyses were not conducted because of heterogenicity of the included studies and of the interventions and outcomes. A narrative summary was presented.

Results

5 RCTS were initially included.
4 studies were considered to be at moderate risk of bias and one at high risk which was excluded from further analyses.
Follow-up periods ranged from 3 months to 3 years.
Interventions included oral hygiene instruction, professional cleaning, difference fluoride varnishes and silver diamine fluoride (SDF) at different frequencies.
Various indices were used to assess root caries.
All 4 included studies demonstrated a positive effect on reduction of root caries.

Conclusions

The authors concluded: –

Based on the available literature it is not possible to conclusively determine the effect of domiciliary professional oral care on root caries development and progression in care- dependent older adults. Future studies in this field should use a standardized protocol for RCT studies with similar study design, interventions, outcomes, and follow-up periods to enable comparison and meta-analysis.

Comments

Recently we looked at another review (Dental Elf – 23^rd Sep 2022) that looked more broadly at professionally applied fluoride treatments for preventing and arresting dental caries in older adults aged 60 and above. This new review focuses on root caries in care dependent adults over the age of 60. The reviewers registered a protocol on PROSPERO and have searched a range of databases however only a small number of RCTs were identified and the variation across the studies of the interventions and outcomes meant that only a narrative summary could be undertaken. With the ageing population expected to double by 2050 and improvement in oral health leading to increased retention of teeth the need to prevent and arrest disease in older population will increase so addition high quality well-reported studies are needed to determine the most effective approaches. Development of common outcome sets would also be helpful in allowing future evidence synthesis.

Links

Primary Paper

Morén E, Skott P, Edman K, Gavriilidou N, Wårdh I, Domeij H. The Effect of Domiciliary Professional Oral Care on Root Caries Progression in Care-Dependent Older Adults: A Systematic Review. J Clin Med. 2023 Apr 6;12(7):2748. doi: 10.3390/jcm12072748. PMID: 37048831; PMCID: PMC10094771.

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