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Background: Inadequate daily oral hygiene care of dental prostheses could worsen general health of frail older people. The index of Augsburger and Elahi is often recommended to assess maxillary dental prosthesis plaque (DPP)., Objective: To assess the reliability of an expanded and standardised DPP index of Augsburger and Elahi in trained and untrained examiners, and to determine the applicability of the index in community-dwelling frail older people., Methods: Ten community-dwelling frail older persons with complete and partial removable dental prostheses (RDPs) (mean ± SD age = 87.9 ± 8.4 years) participated. Seven persons were revisited after 3 months. The index was expanded with mandibular RDPs. Standardisation was achieved with a specially designed reference sheet. The RDPs were photographed after plaque colouring. Two trained examiners scored the photographs; thereafter, two untrained examiners. One trained examiner scored the photographs again after 3 weeks. Changes in DPP over the 3-month period were assessed with Wilcoxon signed-rank test. Inter- and intra-examiner reliability was assessed with intraclass correlation coefficients (ICCs)., Results: The DPP scores did not change significantly over time (Z = -0.594, p = 0.553). Inter-examiner reliability was excellent in the trained examiners (ICC = 0.859-0.947), and fair-to-good in the untrained examiners (ICC = 0.671-0.703). Intra-examiner reliability was excellent (ICC = 0.941-0.962)., Conclusion: The proposed expansion and standardisation of the DPP index has an excellent inter- and intra-examiner reliability when performed by trained examiners, and a fair-to-good inter-examiner reliability by untrained examiners. Therefore, the index could be recommended for application in dental prostheses-wearing older persons and could be useful for awareness and education of professional and informal caregivers and the older persons themselves., Trail Registration: The Netherlands Trail Register NTR6159., (© 2024 The Author(s). Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

Background: Older people are encouraged to remain community dwelling, even when they become care-dependent. Not every dental practice is prepared or able to provide care to community-dwelling frail older people, while their ability to maintain oral health and to visit a dentist is decreasing, amongst others due to multiple chronic diseases and/or mobility problems. The public oral health project 'Don't forget the mouth! (DFTM!) aimed to improve the oral health of this population, by means of early recognition of decreased oral health as well as by establishing interprofessional care. A process evaluation was designed to scientifically evaluate the implementation of this project., Methods: The project was implemented in 14 towns in The Netherlands. In each town, health care professionals from a general practice, a dental practice, and a homecare organization participated. The process evaluation framework focused on fidelity, dose, adaptation, and reach. Each of the items were examined on levels of implementation: macro-level, meso-level, and micro-level. Mixed methods (i.e., quantitative and qualitative methods) were used for data collection., Results: The experiences of 50 health care professionals were evaluated with questionnaires, 22 semi-structured interviews were conducted, and the oral health of 407 community-dwelling frail older people was assessed. On each level of implementation, oral health care was integrated in the daily routine. On macro-level, education was planned (dose, adaption), and dental practices organized home visits (adaption). On meso-level, health care professionals attended meetings of the project (fidelity), worked interprofessionally, and used a screening-referral tool of the project DFTM! in daily practice (dose, adaption, reach). On micro-level, the frail older people participated in the screening of oral health (fidelity, dose), had their daily oral hygiene care observed (adaption) and supported if necessary, and some had themselves referred to a dental practice (reach). The semi-structured interviews also showed that the project increased the oral health awareness amongst health care professionals., Conclusions: The project DFTM! was, in general, implemented and delivered as planned. Factors that contributed positively to the implementation were identified. With large-scale implementation, attention is needed regarding the poor accessibility of the oral health care professional, financial issues, and increased work pressure. Trial registration The Netherlands Trial Register NTR6159, registration done on December 13th 2016. URL: https://www.trialregister.nl/trial/6028., (© 2021. The Author(s).)

Background: The oral health of community dwelling frail older people is poor, and depends on the oral health care provisions available within their own community. The implementation project 'Don't forget the mouth!' (i.e., the intervention) was created with the aim of maintaining and improving the oral health and the general health of community dwelling frail older people, with education and interdisciplinary collaborations of health care professionals and informal caregivers. Critical scientific assessment of the intervention will be described in this study protocol, focused on community dwelling older people with dementia. Methods: This protocol describes a prospective longitudinal single-blind multicentre study, which will take place in 14 towns, each with an intervention and a control group receiving oral health care as usual. Assessment will take place four times during 12 months (i.e., at baseline, after 3, 6, and 12 months). Participants are 65 years and older, community dwelling, and suspected of dementia by their home care worker. The home care organizations will inform, and approach their clients about the study, before the researcher will reach out. The effectiveness of the intervention will be determined with the primary outcome variable 'oral hygiene', assessed through the presence of dental plaque (DP) or dental prosthetic plaque (DPP). The secondary outcome variables are: 'oral health', 'oral health related quality of life', 'oral health care behaviour', 'general health and care dependency', and 'compliance of the health care professionals'. Discussion: This protocol aims to assess the effectiveness of the implementation project 'Don't forget the mouth!' focused on community dwelling older people with dementia. The strengths of the current study are the national roll-out of the intervention, interdisciplinary collaborations and education, and the scientific evaluation over the course of 12 months. The threats and weaknesses are in the recruitment procedure, and the adherence and compliance of the health care professionals to the project. Trial registration: The Netherlands Trail Register NTR6159. [ABSTRACT FROM AUTHOR]