Review on Feasibility and Implementation of Interventions on Improving Oral Health Among Older Adults in Care Homes

Abstract

BACKGROUND Older adults in care homes experience high, preventable burdens of oral disease (caries, periodontal problems, tooth loss, xerostomia) that impair eating, communication and quality of life, and increase risks such as aspiration pneumonia. Workforce constraints, competing care priorities, and variable access to dental services make consistent daily mouth care difficult. UK guidance (NICE NG48) calls for routine oral-health assessment, individualised care plans and access to dental services, yet inspections still report gaps in training, continuity and access. AIM To review and synthesise evidence on the feasibility and implementation of interventions to improve oral health for older adults living in care homes. METHODS A narrative literature review was conducted of studies published from January 2015 to July 2025, focusing on feasibility (acceptability, recruitment/retention, fidelity, practicality) and implementation outcomes (adoption, integration, sustainability). Ovid MEDLINE was searched using combined blocks for oral health, care-home settings, older adults, and feasibility/implementation constructs. In total, 486 records were retrieved; single-reviewer screening and full-text assessment yielded 24 eligible studies. Data were synthesised narratively due to heterogeneity. 3 RESULTS Twenty-four studies were included: eight feasibility evaluations and sixteen implementation studies. Feasibility signals were strongest when oral care was embedded into routine workflows and supported by on-ward coaching/facilitation; documentation burden, staff turnover and resident attrition were common risks. Implementation evidence indicated that multi-component programmes combining staff education with regular coaching, integration of assessment and care-planning, local champions/leadership, and timely access to dental professionals (including tele-models) most consistently improved processes and, in stronger studies, resident hygiene outcomes. Barriers included time pressure, high documentation load and “education-only” approaches without reinforcement. CONCLUSION Interventions to improve oral health in care homes are most feasible and implementable when integrated, coached and system-level rather than one-off training. Future work should use theory-informed pragmatic designs that pre-specify feasibility/implementation outcomes, include standardised resident measures (e.g., plaque/gingival indices, denture hygiene, OHRQoL), and embed economic evaluation to inform scale-up.