Table 1 Effectiveness of intervention to oral health promotion among older people

1

Keyong E (2019) [23]

Thailand

RCT

All: n = 162

Age: 60–74 y

Female: n = 79

Male: n = 77

I: n = 79

C: n = 77

Intervention: Older people in intervention group received oral hygiene care educational programs based on the HBM theory

Baseline: Educations was about health risk, disease severity, and benefit of behavior changes, and then oral health‑related knowledge. Education was conducted by two trained nurses for 4–5 groups in 30–35 min sessions

Month 1: Follow‑up oral health behavior and a review of oral health‑care skills and knowledge

Month 3: Phone calls to ensure compliance and to review oral health‑care skills and knowledge

Control: Only regular oral health promotion

After 6 months, perceived severity, perceived severity, perceived benefits, perceived barriers and Self‑efficacy were statistically significant between two groups (p < 0.05). Moreover, Plaque, index score, gingival index score and clinical attachment loss (p < 0.05)

Conclusion: This oral health promotion program improved oral health perception, behavior, and oral health status of the older people

Health Belief Model

(HBM)

2

Ki JY

(2021)

South Korea

RCT

All: n = 46

Age: 65–74 y

Female: n = 20

Male: n = 20

I: n = 24

C: n = 22

Intervention: Older people in intervention group received oral health education using a mobile app (OHEMA)

Baseline: Educations was about customized oral health care management, oral exercises, and intraoral and extraoral massage methods for 50 min/session, once a week, for 6 weeks

6 weeks: follow up oral health behavior and a review of oral health care skills and knowledge

Control: Did not undergo any oral hygiene education or OHEMA

After 6 weeks, tongue pressure increased, subjective oral dryness, un stimulated salivary flow rate were statistically significant between two groups (p < 0.001)

Conclusion: OHEMA appears to be a useful tool for oral health education for the older people as it improved the SWAL-QoL, with increased tongue pressure and reduced oral dryness

3

Lee KH

(2020) [33] 

South Korea

Quasi-experimental

All: n = 120

Age: > 65 y

Female: n = 87

Male: n = 15

I₁: n = 36

I₂: n = 35

C: n = 31

Intervention (Intervention group II): Older people in intervention group received oral health education program using a workbook, immediately after the lecture

Baseline: Oral health education was about oral health knowledge, oral health recognition, O’Leary index, tongue coating index; at once a week for 5 weeks

6 weeks: Follow-up oral health behavior and a review of oral health care skills and knowledge

Control (Intervention group I): Only received lectures on oral health education

After one-week, significant increase oral health knowledge, oral health recognition, decrease on the O’Leary index and tongue coating index; in both intervention groups

Conclusions: The oral health education program using the workbook increased knowledge and recognition of oral health and lowered the O’Leary and tongue coating indexes. Hence, the use of a workbook may facilitate the effectiveness of oral health education for older people

4

Lee KH

(2021) [25]

South Korea

RCT

All: n = 73

Age: ≥ 65 y

Female: n = 62

Male: n = 11

Non-app use: n = 25

App use: n = 22

C: n = 26

Intervention: (App use group): received oral health education using a smartphone app and workbook activities

Baseline: Oral health education was about oral health knowledge, oral health recognition, O’Leary index, tongue coating index; twice a week for five weeks

6 weeks: Follow up oral health behavior and a review of oral health care skills and knowledge

Control (Non-app use group): Control group received lecture-based oral health education using power point presentations and participated in workbook activities

After 6 weeks, in non-app use group: significant increase oral health knowledge, decrease on the O’Leary index, tongue coating index

In app use group:

significant increase oral health knowledge, oral health perception, decrease on the O’Leary index, tongue coating index. Interaction between time and group was significant only in tongue coating variable

Conclusion: The smartphone app developed in this study carries the possibility to convey informative content for oral health education among older adult

5

Marino RJ

(2016) [34]

Australia

Quasi experimental

All: n = 75

Age: ≥ 55 y

Only female

I: n = 75

Intervention: Intervention group received oral health education based on the ORHIS (Oral Health Information Seminars/Sheets) Model and involved computer interaction with six oral health presentations (web based)

Baseline: Oral health education was oral health attitudes, knowledge, self-efficacy, self-reported oral hygiene practices at twice a week for five weeks

After the intervention: Follow up oral health behavior and a review of oral health care skills and knowledge

Control: There was no control group

After the intervention, significant improvements in oral health attitudes, knowledge, self-efficacy, self-reported oral hygiene practices (p < 0.05)

Conclusion: The e-ORHIS approach was successful in improving oral health knowledge, attitudes and self-efficacy. As such, it represents a helpful approach for the design of (oral) health interventions in older adults

Social Cognitive Theory

(SCT)

6

Ohara Y

(2015) [26]

Japan

RCT

All: n = 47

Age: > 65 y

Gender is not mentioned

I: n = 21

C: n = 17

Intervention: Older people in intervention group received oral hygiene instruction, oral functional exercise and salivary gland massages, via lectures

Baseline: Educations were about oral hygiene instruction, facial and tongue muscle exercise, and salivary gland massage. Education was conducted every 2 weeks for 3 months' six 90-min sessions

After the intervention: Follow up oral diadochokinetic of articulation, swallowing, taste threshold and salivary flow rate

Control: Oral health check-up

After the intervention, resting salivation, the second and third cumulated Repetitive Saliva Swallowing Test times, significantly improved

The threshold for bitterness significantly lowered in the intervention group, compared with control group after 3 months (P < 0.05)

Conclusion: The educational program targeting oral function improvement is effective among the independent older population

7

Powell LV

(1999) [27]

USA

RCT

All: n = 297

Age: > 60 y

Female: n = 163

Male: n = 134

G₁: n = 55

G₂: n = 48

G₃: n = 52

G₄: n = 52

G₅: n = 55

Intervention: Older people in five intervention groups received different caries-preventive strategies on caries progression

Baseline

Group1: Group1 received usual care from a public health department or a private practitioner

Group2: Group2 received an educational program of 2 h duration implemented twice a year

Group3: Group3 received the educational program plus a 0.12% chlorhexidine rinse weekly

Group4: Group4 received the education and chlorhexidine interventions and a fluoride varnish application twice a year

Group5: Group5 received all the above interventions as well as scaling and root planning every 6 months throughout the 3-year study

3-year: Main outcome measures were oral health behavior and a review of oral health‑care skills and knowledge

Control: There was no control group

After 3-year, groups that received usual intraoral procedures (groups 3, 4, and 5) had a 27% reduction for coronal caries events (p = 0.09) and 23% for root caries events (p = 0.15), when compared to the groups that received no intraoral procedures (groups 1 and 2)

Conclusion: The caries progression in this lower-income, ethnically diverse, older population is relatively high. Simple preventive measures (education, chlorhexidine rinses, fluoride varnishes, root planning) result, at best, in only a moderate reduction in caries development

8

Saengtipbovorn S (2014) [35]

Thailand

Quasi-experimental

All: n = 132

Age: > 60

Female: n = 85

Male: n = 47

I: n = 66

C: n = 66

Intervention: Older people in intervention group received lifestyle and oral health education program motivational interviewing (MI)

Baseline: Educations was about type 2 diabetes complications, the prevention of general and oral health complications, the relationship between type 2 diabetes and oral complications, and oral health care, in 20 min; by trained nurse practitioners

Month 3: Main outcome measures were: glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), body mass index (BMI), periodontal status, knowledge, attitude and practice of oral health and diabetes mellitus

Control: Control group received a routine program in the diabetes clinic

After the 3 months, Participants in the intervention group had significantly lower glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), plaque index score, gingival index score, pocket depth, clinical attachment level (CAL), and percentage of bleeding on probing (BOP) when compared to the control group

Conclusions: The combination of lifestyle change and dental care in one program improved both glycemic and periodontal status in the older people with type 2 diabetes

9

Schou L (1989) [29]

UK

RCT

All: n = 201

Age: 48–99 y

Gender is not

mentioned

n = 201

Intervention: Older people in intervention group received dental health education program

Baseline: Educations were about dental health education program

Education was conducted of the three programs

1) Active involvement of residents only,

2) Active involvement of staff only,

3) Active involvement of both staff and residents

Month 2: Follow up oral health and oral hygiene

Control: No educational program

After 2 Month, poor oral health and oral hygiene, high objective need for oral care but low perceived need

Conclusion: The implications of the study arc that groups of older people need to be differentiated further so that only well and not confused older people participate in programs such as this and less well and confused the older people receive regular professional support with oral hygiene

10

Shokouhi E

(2020) [30]

Iran

RCT

All: n = 86

Age: > 60

Female: n = 38

Male: n = 48

I: n = 43

C: n = 43

Intervention: older people in intervention group received variables of oral health related quality of the older people, based on adult learning theory

Baseline: A training program comprised of a combination of in-person training (individual training and group discussion) and non-attendance training (sending educational messages) was prepared and submitted

15 min of individual training based on motivational interviewing methods

researcher-made booklet and a dental modulate was used to improve individual education

Month 1: Main outcome measures were oral health related life quality, and effectiveness of adult learning the

Control: No educational program

After 1-month, educational intervention was significant in terms of overall oral health related quality of life and the overall effectiveness score of adult learning theory (P < 0.001). There was a significant difference between the two groups in terms of the mean change score of three physical, psychosocial, and pain dimensions following the educational

intervention (P < 0.001)

Conclusion: Education based on adult learning theory is recommended for improving oral health related quality of life among the older people

Adult Learning Theory

11

Tellez M

(2019) [31]

USA

RCT

All: n = 180

Age: ≥ 55 y

Female: n = 112

Male: n = 68

G₁: n = 60

G₂: n = 60

C: n = 60

Intervention: Older people in intervention group received oral health education based on the 3 programs: motivational interviewing, traditional oral health education, and standard of care

Baseline: Patients were randomly allocated to TOHE, MI and SC groups

The MI intervention was administered by a Public Health Dental Hygienist (PHDH)

1-year: Main outcome measures were: oral health-related quality of life (OHRQoL), oral health self-efficacy (SE) and oral health knowledge (OHK, between three groups)

Control: Control group received traditional oral health education, standard of care

After 1 year, in intervention group significantly improved oral health-related quality of life (OHRQoL), oral health self-efficacy (SE), oral health knowledge, compared to the control group (P =  < 0.001)

Conclusion: Findings from the study support the fidelity of this intervention and the improvement of all non-clinical outcomes after 12 months amongst the MI group

12

Sun KT

(2021) [36]

Taiwan

Quasi experimental

All: n = 129

Age: ≥ 60 y

Female: n = 93

Male: n = 36

I: n = 72

C: n = 57

Intervention: Older people in intervention group received oral health education materials based on the easy (EZ) to read” concept

Baseline: Health education course of approximately 30 min accompanied by PowerPoint slides

After intervention: Main outcome measures were oral health literacy adult questionnaire complete

Control: Control group received general text material

EZ to read material significantly improved total scores of oral health literacy (p < 0.001)

Conclusions: Introducing the EZ to read model to the design of older adult health education material in rural areas significantly improved their oral health literacy

13

Saengtipbovorn S

(2015) [28]

Thailand

RCT

All: n = 132

Age: > 60 y

Female: n = 85

Male: n = 47

I: n = 66

C: n = 66

Intervention: Older people in intervention group received oral health education

Baseline: Intervention group attended 20-min lifestyle and oral health education, individual lifestyle counseling, application of a self-regulation manual, and individual oral hygiene instruction

At month 3: The intervention group received individual lifestyle counseling and oral hygiene instruction. The intervention group received booster education every visit by viewing a 15-min educational video

After intervention [3, 6 months]: Follow-up for glycemic and periodontal status

Control: Control group received a routine program

After the 6-month, participants in the intervention group had significantly lower glycated hemoglobin, fasting plasma glucose, plaque index, gingival index, probing depth, and attachment loss when compared with the control group

Conclusion: The combination of lifestyle changes and dental care in one program improved both glycemic and periodontal status in older patients with diabetes

14

Zhang W

(2013) [32]

China, Hong Kong

RCT

All: n = 266

Age: 60–89 y

Female: n = 198

Male: n = 68

I₁: n = 98

I₂: n = 84

C: n = 84

Intervention: Older people in intervention groups [2, 3] received oral health education and silver diamine fluoride, oral hygiene instructions

Baseline: group 2 received OHI and silver diamine fluoride (SDF) application annually,

and group 3 was given OHI and SDF application annually, plus an oral health education (OHE) program every 6 months

After intervention: Main outcome measures were new root caries surfaces, arrested root caries surfaces, active root caries surfaces

Control (group 1): Control group received oral hygiene instructions (OHI) annually

After 24 months: Group3 had fewer root surfaces with new caries; and Group3 and group 2 had a great number of active root caries surfaces which became arrested compared with the control group

(Group 1) p < 0.05)