The project ‘Don’t forget the mouth!’

Worldwide, there are 46.8 million people suffering from dementia, and this number continues to rise. It is very important for older people with dementia to have good oral health, since adequate mastication could slow down the decline in their cognition and prevent malnutrition. The oral health of frail older people is poor; both of community dwelling and institutionalized. The demand for (professional) oral health care increases, but the current health care system is not prepared for this growing demand.
The project ‘Don’t forget the mouth! (DFTM!)’ sets out to improve education and to support interdisciplinary collaborations, with the aim to maintain and improve the oral health and general health of community-dwelling frail older people with and without dementia.

This study is set up as a proces evaluation and a prospective longitudinal single-blind multicenter study, and took place in 14 towns in the Netherlands. In each town, 1 homecare organization participates with 2 districts, representing an intervention group and a control group.

The aim of this study is (1) to evaluate the process of implementation and (2) the effectiveness of the project ‘Don’t forget the mouth!’.

The project DFTM! could be implemented as planned, and contributes positively to the oral health

The health care professionals in the intervention group will be encouraged to form multidisciplinary collaborations, and obtain improved education on maintaining and improving oral health and general health of community-dwelling older people with dementia with the project ‘Don’t forget the mouth!’. The multidisciplinary collaborations and improved education could lead to more time spent on oral care on an everyday basis, and referring participants in the intervention group, who A) did not visit a dentist in the last year, B) have signs of possible oral pain, C) experience problems with mastication, or D) express other mouth problems to the dentist of the intervention group. The indication for spending more time on oral care on an everyday basis and/or referral to a dentist can be done with help of the screening- and referral tool designed by the project ‘Don’t forget the mouth!’.

The healthcare professionals will receive questionnaires about the implementation of the project DFTM! at baseline, after 3 months, 6 months and 12 months. Besides the questionnaires, the healthcare professionals will be invited for a semi-structured interview after 12 months.

The participants will be visited at home at baseline, after 3 months, 6 months, and 1 year. Prior to the visiting at baseline and after 1 year, the participant and caregiver or family member, receive The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS) questionnaires to fill out. During the visits, plaque measurements according to Silness and Löe (DP) and according to Augsburger and Elahi (DPP) will be performed. The Geriatric Oral Health Assessment Index (GOHAI) and oral health care questionnaires will be completed through a personal interview.

The public oral health project DFTM! focuses on improving the oral health and indirectly the general health of community-dwelling frail older people with and without dementia in the Netherlands, through early recognition of decreased oral health and daily oral hygiene care; oral complaints; and interdisciplinary care if needed. Furthermore, the project sets out to improve education and supports interdisciplinary collaborations, to physicians, assistants general health practice, dentists, case managers, district nurses, home care workers, and caregivers. To assess the effectiveness of the project DFTM! (i.e. the intervention), the project will be compared to oral health care as usual.