End Stages of Life and Oral Health Education

Summary: Oral care education enhances the professional care of all healthcare providers but also of individual dental patients. The objective of this study was to test the impact of oral care education on attitudes, knowledge & behavior of dentists in teaching residents in nursing care and oral care facilities. Methods: In this quasi- observational study, the intervention/control group of dentists in a teaching hospital received 6 months of comprehensive oral care education from the same group of dentists who participated in a similar teaching program. The primary outcome was a mean difference in mean scores on the NIMS-IV dental scores at the 6-month interval (p=0.000), but when controlling for the presence or absence of a dentist within the family, there was still a significant effect of the educational interventions on dental health. This study is further evidence that it is not only important but necessary to provide high levels of dental care and maintenance for all patients to maintain the social and economic value of dental services.

oral care education


Why is it that oral care education is important? Simple - Dentists must provide a comprehensive package of preventive services, preventative care, and basic restoration during their careers. This requires a sophisticated level of skills that few dentists are able to consistently exhibit. Residents in care facilities, especially children, suffer from deficiencies in the domains of basic and preventive oral health care and from low perceived awareness of these deficiencies. The effect of such a lack of oral hygiene on oral health and on the performance of these services is as yet unknown but the current study provides a context for identifying what might be needed.

What were the factors associated with the differences in behaviors among the intervention and control groups? Overall, there were few significant differences in attitudes and beliefs across the two groups. However, there was a remarkable difference in the relative importance of beliefs about oral care after the treatment period and before the treatment. In the intervention group, those who held consistently negative beliefs about routine oral care were less likely to report improved oral health than those in the control group who held consistent positive beliefs about regular oral care.

Why did the difference in beliefs occur? It is unclear but the results of this study suggest that it may have resulted from the mere fact that the treatment was introduced into the care facility sooner rather than later, thus creating a sense of urgency among the participants to treat poor oral health. Other studies have suggested that the results are driven by the fact that treatment is more readily available to dentists in the intervention group. For example, some studies have shown that oral care education can help reduce dental visits by as much as half and this might account for the increased level of expectation among participants that treatment would improve their oral health.

How should we interpret the results of the current study? Oral health care providers should consider the strengths and gaps between the results of part 1 and part 2 and use this information to determine how to integrate the two into their overall approach. Although there was a significant difference between the groups regarding beliefs about routine oral care, most residents in the intervention group showed improvement in both areas. The differences in the quality of the care provided (best practice guidelines were used for both parts of the study) and the number of encounters with dentists (the intervention group had fewer encounters) were not statistically significant and therefore were not included in the analysis.

Of note is the fact that the study also showed that the number of encounters with dentists was unrelated to the patient's ability to provide ongoing oral care. Most residents in the interventions had at least one dental visit per year compared to about one or two in the case of those in the long-term care group. This may suggest that providing ongoing care is more beneficial to patients than just getting treatment when needed.

The focus on oral care best practices also deserves some mention because it illustrates two important points. First, that there is a big need for training and continuing education in order to maintain high quality patient care. Second, that the focus should be on prevention rather than treatment. The study did not separate treatments for dementia specifically from the other two groups and so should be interpreted with this in mind. However, what is apparent is that the interventions for dementia should target those areas where prevention is the best possible - specifically responding appropriately to facial cues and providing appropriate stimulation and interaction.

Conclusion: The study makes some important and useful recommendations to improve end stages of life and how we can improve our response to them. The focus on dementia palliative care was very brief and has implications for many aspects of the treatment of people with this condition. The next phase of research will examine larger groups of older adults with dementia to establish whether these practices can help to prolong life. The importance of managing end stages of life goes beyond disease prevention. Providing consistent and effective end stage management supports the patient's ability to manage future challenges and to achieve optimal functional independence.