Evidence-Based Oral Health Care Tool and Treatment Plan for Vulnerable Population

Objectives: Oral health care (OHC) despite its undeniable importance to general health, has been relegated to the sidelines in medical practice for long, resulting in disparities and burdens in the health. We aim to investigate the effectiveness of the Mouth and Oral Health Individualized Treatment (MOHIT) plan compared to the Existing Oral Care Plan (EOCP) in patients with acquired brain injury (ABI) admitted at neurorehabilitation center.
Methods: In an experimental trial, out of 126 ABI individuals screened, 86 patients received and completed either a three-week MOHIT (n=34) or EOCP (n=52) plan. Based on two-step assessment process, the MOHIT group received an individualized (dependent/non-dependent on caregivers) and item-wise (tooth-plaque, tooth-caries, tongue, gingiva, odor, saliva, mucous membrane, lips and candidiasis) OHC plan whereas EOCP received a routine OHC plan provided at the center. Changes in oral health were evaluated based on screening [modified bedside oral examination (mBOE)] and clinical assessment [plaque, caries, bleeding on probing (BOP), tongue-coating, odor, salivary flow rate etc.] at weeks 1 and 4 for both groups. The relative differences (week 4 vs. baseline) between MOHIT and EOCP were analyzed within and between the groups by linear mixed-effects models for continuous outcomes and cumulative linkage mixed models with Laplace approximation for categorical outcomes.
Results: Within-group comparisons, the EOCP showed improvement in various mBOE scores and clinical assessments, but the significance was higher in the MOHIT group. The MOHIT group outperformed the EOCP group displaying greater improvements in mBOE overall score (P=0.008), mBOE sub scores of gingiva, tongue, odor, saliva and lip (P<0.044) and clinical parameters, including, plaque, BOP, tongue coating, odor and oral candidiasis (P<0.022).
Conclusions: Our findings provide empirical evidence that the new individualized (dependent/ non-dependent on caregivers) and item-specific (tooth, tongue, gingiva, etc.) OHC plan, guided by a stepwise diagnostic tool, significantly improved various oral health parameters in a vulnerable ABI population. The MOHIT plan further needs to be validated and feasibly tested among nurses before randomized clinical trials can be performed for facilitating translational research into clinical practice.