Oral health interventions and their effectiveness for dependent older adults: a systematic review of outcomes and outcome measures used in clinical research

Objectives
To identify oral health outcomes and outcome measures reported in studies examining oral health interventions among dependent older adults, as an initial step in the development of a core outcome set (COS).

Data
Intervention studies aimed at improving oral health of dependent older adults aged ≥60 years, residing in care homes, or at home, were included. The quality of included studies was evaluated using the Cochrane risk-of-bias tool (RoB 2) and Risk of Bias In non-randomized Studies of Interventions (ROBINS-I).

Sources
Medline and Embase via Ovid, Cochrane CENTRAL, and Web of Science, up to August 2025

Study selection and results
Eighty-four studies were included. Interventions were primarily classified into four categories: caregiver training and education (n = 21), oral healthcare interventions (n = 25), health professionals’ interventions (n = 31) and other interventions (n = 7). The reported outcomes and outcome measures varied considerably across studies and can be broadly grouped into six domains: oral hygiene, dentition status, periodontal status, oral mucosal status, overall oral health, and other outcomes. The most reported outcome was oral hygiene, with the Plaque Index being the most frequently used measure, followed by the Gingival Index. Other commonly reported outcome measures include Decayed, Missing, and Filled Teeth/Surfaces (DMFT/S), salivary levels of bacterial pathogens, and the Oral Health Assessment Tool (OHAT).

Conclusions
The outcomes and outcome measures reported across studies evaluating oral health interventions in dependent older adults were highly heterogenous. There is limited high-quality evidence in this area, highlighting the need for further research with robust study designs. The development and adoption of a COS would be valuable towards improving evidence-based dentistry and quality of care for this population.

Clinical Significance
Findings highlight the need for a COS to guide future research and ensure that outcomes are standardised and relevant to all stakeholders, and enable robust conclusions to inform clinical practice.