{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T12:05:04Z","timestamp":1784721904137,"version":"3.55.0"},"reference-count":39,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR128773"],"award-info":[{"award-number":["NIHR128773"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Comm Dent Oral Epid"],"abstract":"ABSTRACT<\/jats:title>\n \n Objectives<\/jats:title>\n To determine whether Dental Therapists and Dental Nurses could reduce plaque levels of dependent older adults residing in care homes and assisted living settings, when compared to \u2018treatment as usual\u2019.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A two\u2010arm pragmatic cluster randomised controlled trial over a 6\u2010month period was undertaken based on an a priori assumption of superiority. Forty\u2010eight dependent settings across Wales, North\u2010West England, London and Northern Ireland were recruited. Dependent settings were excluded if they solely focused on end\u2010of\u2010life or palliative care or were already participating in an oral health prevention programme. Residents were excluded if they were below 65\u2009years of age or if they were receiving end\u2010of\u2010life or palliative care. Dependent settings were randomised using an adaptive algorithm, which generated the randomisation sequence. After allocation, the Chief Investigator, Principal Investigators and the trial statistician were blinded until the trial was completed and the analysis was complete. Due to the nature of the intervention, outcome assessors, those delivering the intervention and the residents were not blinded. Dental Therapists provided routine dental care according to their Scope of Practice. Dental Nurses administered fluoride varnish, oversaw the use of high\u2010strength fluoride toothpaste, and sought to improve the level of day\u2010to\u2010day prevention offered by the formal carers. Current practice formed the control arm. In the United Kingdom, this is often ad hoc and relies on dentists, if available, visiting residents presenting with clinical symptoms. The intervention period lasted for 6 months. The primary outcome measure was the proportion of residents that demonstrated a 50% reduction in the Silness and L\u00f6e plaque index. Secondary outcome measures were the number of new carious lesions (coronal and root caries), bleeding on probing, Oral Impacts on Daily Performances, EuroQol five dimensions questionnaire (quality of life measure), oral symptoms, episodes of pain, and episodes of unscheduled care, and the number of onward referrals to dentists.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Twenty\u2010four dependent settings were allocated to receive the intervention and 24 continued with \u2018treatment as usual\u2019. 41.7% of the settings were in London, 33.3% were in Wales or the Northwest of England, and 25.0% of the settings were in Northern Ireland. One hundred and twenty\u2010two residents were allocated to the control arm and 142 residents in the intervention arm. The mean age was 85\u2009years and 67.2% were female. Levels of cognitive impairment were high in both arms (mean score 13.7 on the Six Item Cognitive Impairment Test). No statistically significant differences were found in the primary or secondary outcome measures at 6\u2010months. No differences were apparent in the number of adverse events related to the trial by group.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n A 6\u2010month intervention using Dental Therapists and Dental Nurses did not produce any measurable improvements in oral health within dependent settings when compared to treatment as usual. High levels of cognitive impairment may have contributed to the lack of any effect seen.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n The study was registered with ISRCTN: ISRCTN16332897 (\n https:\/\/doi.org\/10.1186\/ISRCTN16332897<\/jats:ext-link>\n ) on 3 December 2021 and the protocol was published in 2022 (\n https:\/\/doi.org\/10.1186\/s13063\u2010022\u201006487\u20103<\/jats:ext-link>\n )\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/cdoe.70089","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T11:48:26Z","timestamp":1784720906000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Using Role Substitution to Improve Oral Health of Dependent Older People Residing in Care Homes and Assisted Living Settings in the United Kingdom"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1878-9030","authenticated-orcid":false,"given":"Paul 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