What do systematic reviews say?

Strategies to integrate oral health into primary care (e.g., training/education of non-dental primary care professionals, policy/financing and health-insurance changes, colocation of dental and medical services, interprofessional and community-health-worker collaboration, teledentistry, integrated oral health assessment tools, school-based activities) vs No integration / usual care (or pre-integration baseline; many included studies uncontrolled)

Most strategies to integrate oral health into primary care were associated with improved access to oral healthcare (19 studies, narrative synthesis; ungraded).

• Strategies to integrate oral health into primary care: a systematic review. 2023 All outcomes

  Primary care, community, school, and aged-care/residential/nursing-home settings
  Access to oral healthcare was the primary outcome most studied (n=19). Most studies reported results favouring the integration strategy, including improvements in referral pathways, documentation processes, operating…
  19 studies
  GRADE not reported

Chlorhexidine (mouthrinse or gel), as part of oral hygiene care vs placebo or usual care

The review found no eligible studies for this question.

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  The outcome of caregivers' preferences was not reported by any study in this comparison.
  0 studies
  No studies found

Professional oral care vs Usual oral care

• Oral care measures for preventing nursing home‐acquired pneumonia 2022 · Cochrane All outcomes

  8-30 months
  Incidence of NHAP, follow-up 8-30 months, 5018 (5 studies), Low. Not pooled (individual and cluster-randomised designs, varying effect measures and follow-up). Component estimates: Bourigault HR 0.65 (0.29 to 1.46;…
  5 studies · 5018 participants
  Low

Professional oral care vs Usual oral care

• Oral care measures for preventing nursing home‐acquired pneumonia 2022 · Cochrane All outcomes

  12-30 months
  All-cause mortality, follow-up 12-30 months, 3764 (3 studies), Very low. Not pooled. Adachi RR 0.80 (0.40 to 1.58; 88); Juthani-Mehta HR 1.16 (0.88 to 1.53; 834); Zimmerman adjusted IRR 0.83 (0.61 to 1.12; 1606).…
  3 studies · 3764 participants
  Very low

Professional oral care vs Usual oral care

Professional oral care may leads to lower mortality (pneumonia-associated) compared with usual oral care (low certainty).

• Oral care measures for preventing nursing home‐acquired pneumonia 2022 · Cochrane All outcomes

  24 months
  RR 0.43 [0.25, 0.76]
  2 studies · 454 participants
  Low

Professional oral care vs Usual oral care

Professional oral care led to lower incidence or prevalence of fever compared with usual oral care; GRADE not reported.

• Oral care measures for preventing nursing home‐acquired pneumonia 2022 · Cochrane All outcomes

  24 months
  RR 0.49 [0.33, 0.75]
  1 study · 366 participants
  GRADE not reported

Professional oral care vs Usual oral care

• Oral care measures for preventing nursing home‐acquired pneumonia 2022 · Cochrane All outcomes
  Measured in only 1 study (834 participants), which reported no serious events and 64 non-serious events, the most common of which were oral cavity disturbances (not defined) and dental staining.
  1 study · 834 participants
  GRADE not reported

Professional oral care vs Usual oral care

Professional oral care led to higher change in data on economics and quality of life compared with usual oral care; GRADE not reported.

• Oral care measures for preventing nursing home‐acquired pneumonia 2022 · Cochrane All outcomes

  24 months
  MD 1.5 [0.32, 2.68]
  1 study · 322 participants
  GRADE not reported

Professional oral care vs Usual oral care

Professional oral care led to higher oral health indices compared with usual oral care; GRADE not reported.

• Oral care measures for preventing nursing home‐acquired pneumonia 2022 · Cochrane All outcomes

  24 months
  RR 2.81 [1.39, 5.69]
  1 study · 199 participants
  GRADE not reported

Professional oral care vs Usual oral care

The review found no eligible studies for this question.

• Oral care measures for preventing nursing home‐acquired pneumonia 2022 · Cochrane All outcomes
  No studies measured change in systemic antibiotic use.
  0 studies
  No studies found

Strategies to integrate oral health into primary care (e.g., training/education of non-dental primary care professionals, policy/financing and health-insurance changes, colocation of dental and medical services, interprofessional and community-health-worker collaboration, teledentistry, integrated oral health assessment tools, school-based activities) vs No integration / usual care (or pre-integration baseline; many included studies uncontrolled)

Integration strategies were generally associated with positive oral health knowledge, attitudes and perceptions among staff and patients (16 studies, narrative synthesis; ungraded).

• Strategies to integrate oral health into primary care: a systematic review. 2023 All outcomes

  Primary care, community, school, and aged-care/residential/nursing-home settings
  Knowledge/attitudes/perceptions of staff and patients was the second most studied outcome (n=16). Patient and staff perceptions on various aspects of the integration strategy were usually reported as positive.…
  16 studies
  GRADE not reported

Strategies to integrate oral health into primary care (e.g., training/education of non-dental primary care professionals, policy/financing and health-insurance changes, colocation of dental and medical services, interprofessional and community-health-worker collaboration, teledentistry, integrated oral health assessment tools, school-based activities) vs No integration / usual care (or pre-integration baseline; many included studies uncontrolled)

Key barriers to implementing integration strategies were time/staff/resource constraints and lack of organisational support, while facilitators were professionals' knowledge and attitudes and supportive governance/leadership (qualitative; ungraded).

• Strategies to integrate oral health into primary care: a systematic review. 2023 All outcomes

  Primary care, community, school, and aged-care/residential/nursing-home settings
  The most commonly studied qualitative outcomes were barriers and facilitators related to the strategy implementation process. Reported barriers were time and staff constraints, resource limitations and lack of…
  15 studies
  GRADE not reported

Strategies to integrate oral health into primary care (e.g., training/education of non-dental primary care professionals, policy/financing and health-insurance changes, colocation of dental and medical services, interprofessional and community-health-worker collaboration, teledentistry, integrated oral health assessment tools, school-based activities) vs No integration / usual care (or pre-integration baseline; many included studies uncontrolled)

Most studies reported improved oral disease outcomes with integration strategies (8 of 9 studies improved, 1 no change; 9 studies, narrative synthesis; ungraded).

• Strategies to integrate oral health into primary care: a systematic review. 2023 All outcomes

  Primary care, community, school, and aged-care/residential/nursing-home settings
  Nine studies reported oral disease outcomes, seven of which measured change in dental caries estimates. Eight of the nine studies reported improved oral disease outcomes; one (Vichayanrat 2012) reported no change in…
  9 studies
  GRADE not reported

Oral hygiene interventions (mechanical plaque removal): knowledge-based, behavioural, or skills training for people with ID or their carers vs Usual care, no care, or a similar alternative intervention

The review found no eligible studies for this question.

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes
  No studies measured dental caries levels. One RCT (Shaw 1991, Comparison 5) assessed DMFT at baseline only and did not report caries at any later time point.
  0 studies
  No studies found

Oral hygiene interventions (mechanical plaque removal): knowledge-based, behavioural, or skills training for people with ID or their carers vs Usual care, no care, or a similar alternative intervention

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes
  Adverse/unintended effects addressed narratively: 10 of 34 studies investigated or reported negative unintended or adverse effects (e.g. difficulty with the electric or 3-headed toothbrushes, being frightened by the…
  10 studies
  GRADE not reported

Oral hygiene interventions (mechanical plaque removal): knowledge-based, behavioural, or skills training for people with ID or their carers vs Usual care, no care, or a similar alternative intervention

The review found no eligible studies for this question.

• Oral hygiene interventions for people with intellectual disabilities 2019 · Cochrane All outcomes
  No studies measured quality of life changes or long-term, patient-centred outcomes as formal outcomes; some studies commented on quality of life only in the discussion or conclusion sections.
  0 studies
  No studies found

Chlorhexidine (mouthrinse or gel), as part of oral hygiene care vs placebo or usual care

Chlorhexidine (mouthrinse or gel), as part of oral hygiene care probably leads to lower incidence of VAP compared with placebo or usual care (moderate certainty).

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes

  Follow-up: mean 1 month
  RR 0.67 [0.47, 0.97]
  13 studies · 1206 participants
  Moderate

Chlorhexidine (mouthrinse or gel), as part of oral hygiene care vs placebo or usual care

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  Adverse effects: information from 2 studies; one stated there were none, the other reported mild reversible irritation of the oral mucosa; very low certainty. There was a lack of evidence about adverse effects.
  2 studies
  Very low

Chlorhexidine (mouthrinse or gel), as part of oral hygiene care vs placebo or usual care

Chlorhexidine (mouthrinse or gel), as part of oral hygiene care showed no clear difference in mortality compared with placebo or usual care (moderate certainty).

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes

  Follow-up: mean 1 month
  RR 1.03 [0.80, 1.33]
  9 studies · 944 participants
  Moderate

Chlorhexidine (mouthrinse or gel), as part of oral hygiene care vs placebo or usual care

• Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia 2020 · Cochrane All outcomes
  Plaque index: Fu 2019 found a significant reduction in the chlorhexidine group; Ozcaka 2012 and Scannapieco 2009 found no difference; 3 studies; no usable pooled estimate.
  3 studies
  GRADE not reported